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HomeMy WebLinkAboutCUMBERLAND FARMS #2326 - FOOD (2) I CUMBERLAND FARMS #2326 395 W.MAIN ST. ,HYANNIS Town of Barnstable Bohn TD. OF HEALTH man Board of Health Donald A.Gaudagnoli,M.D. aAn.I::�rABLr- F.P.(Thomas)Lee,. Daniel Luczkow,M.D. Alt. �,� sy4• ,� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 127 Issue Date: 01/01/2022 DBA: CUMBERLAND FARMS #2326 OWNER: CUMBERLAND FARMS,INC. Location of Establishment: 395 WEST MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: RETAIL WITH FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE i Restrictions: i Town of Barnstable � Initials: _ ._ $� c ,A ,ASSffABM : Inspectional Services .,� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE J NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ��l.>h,���I�•1� �cz r�5' OS 3076 ADDRESS OF FOOD ESTABLISHMENT: ��n sy= , O �� MAILING ADDRESS(IF DIFFERENT FROM ABOVE):LSalvucci@cumberiandfarms.com cumberlandfarms.com E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 7�D- Oaa'7 TOTAL NUMBER OF BATHROOMS: _ WELL WATER:YES NO !�'...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYP_E,OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) /y FFOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL.MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-8624644 Q:\Application FonnsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT C"j"kC r/c2 n61 .yh G427a-4LE SOLE OWNER: YES/NO _ OWNERPHON E# ADDRESS � 42>)e-5rielGaw h� CORPORATE OWNER: r2 r=i Gz/n4i/e— CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: a a Pnlf'1S ��l e- mq je'5 List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. "ATTACH COPIES OF CERTIFICATES" The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date Ply 3 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FonnsTOODAPP REV3-2019.doc 5 � Town of Barnstable BOARD OF HEALTH ^� John T.Norman Board of Health Donald A.Gaudagnoli,M.D. vm"M+:srtBtr, Paul J.Canniff,D.M.D. MA$ F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 127 Issue Date: 01/01/2021 DBA: CUMBERLAND FARMS #2326 OWNER: CUMBERLAND FARMS,INC. Location of Establishment: 395 WEST MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �I Zm Town Of BarnstableInspectional Services MASS. .,0 Public Health Division �e,u+ Thomas.McKean,Director 200-Main Street,H annis,TyIA 02601 Office: 508-862-4644 Fax: 508-190-6304 APPLICATION FOR PERMIT TO OPERATE►ALFOOD ESTABLISHMENT DATE X9 f� 07,6 NEW OWNERSHIP RENEWAL, `�✓ `1E OF FOOD ESTABLISHMENT: �um�P� !;�07S NA, ADDRESS OF FOOD ESTABLISHMENT: , �� LQ�� Sr , �.Aw utPARTMENT MAILING ADDRESS(IF DI EG AMERICA LLCFFERENT FROM ABOVE): 165 FLANDERS ROAD LSatvucci@cumbertandfarms.com TRC Rf�I IC;H NAA 01581 E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: at WELL WATER: YES__n0 ✓ —(ANNUAL WATER ANALYSISREQUIRED) ANNUAL: '� SEASONAL: DATES OF OPERATION:_/_�� TO / NUMBER OF SEATS: INSIDE:"'OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS.. IS WAIT STAFF PROVIDED FOR OUTSIDE.DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYP E OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) ABED& BREAKFAST CONTINENTAL BREAKFAST �COTTAGE:FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD _FROZEN DAIRY DESSERT MACHINES...,(MONTHLY LAB ANALYSIS REQUIRED) _CATERING (CATERING NOTICE REQUIRED.BEFORE EVENT(SEE PAGE#2) *** SEASONAL.MOBILE&NEW FOOD'ONLY*** _REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QaApplicatipn FormsT00DAPP 2020.doc OWNER.INFORMATION:. FULL NAME OF APPLICANT�t.G`►t t7� �n r�5 ""�'�G ` SOLE OWNER: YES/NO;� O,N'NERPHONE#' - ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: N CHARGE OF DAILY OPERATIONS: [�6? Jiro 5 __ PERSON I List (2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must:have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES The Health Div. wil1,NOT use past}ears'records.You must prove new copies and POST THE CERTIFICATES at your food estab.fishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION"* SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.. prior to ot)enina!l Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. ;Failure to do so:will.result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within.the To-,}m of Barnstable must notify theTown by fax or inailprior.to catering event. You must complete.a catering notice found at http//r�ww w,townofbarnstable.us/healthdivision/at)i)lications-IsP- event. COOKING,: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT'IS YOUR RESPONSIBILITY TO RETUR'r THE COMPLETED APPLICATION(S)A:'�D REQUIRED FEES BY DEC lst. Q\Appli.cation FonnsIFOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. F.P. Thomas Lee 200 Main Street, Hyannis, MA 02601 IDaniel Luczkow,Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 127 Issue Date: 1/1/2021 DBA: CUMBERLAND FARMS #2326 OWNER: CUMBERLAND FARMS,INC. Location of Establishment: 395 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES: $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY OfficeFor Initials: ofI►iE'a,,a�. Town of Only. C Date Paid I L Amt_Pd aaSTAR Inspectional Services 6 ��� Public Health Divisions ao�17�. ©1 �,t a Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT-.PERMIT.APPLICATION on-Flavored i 12/20/2020 X DATE ...... NEW BUSINESS OWNERSHIP RENEWAL NAME OF TOBACCO ESTABLISHMENT: CUMBERLAND FARMS_ #2326 r MAIN ST ADDRESS OF TOBACCO ESTABLISHMENT: .. 395 E.__ MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 165 Flanders Rd._Westboro.0 h Ma. 01581 E-MAIL ADDRESS:. LSalvucci@cumberlandfarms.com TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: 5� 08) 790 . 0227 OWNER'S NAME: Cumberland Farms, Inc. OWNER'S PH#F)08 270 1504D. OWNER'S ADDRESS: 165 Flanders Rd. Westborough Ma. 01581 ti CORPORATE NAME: CUMBERLAND FARMS INC. CORPORATE ADDRESS: 165 Flanders Rd. Westborough Ma. 0158.1 CORPORATE FID# _04-2843586 ANNUAL:X SEASONAL: DATES OF OPERATION:_1 / TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE COMMA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: hU�s://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: htt ://malegistature Gov/I aws/Ge.neralLaw,s/PartIV/TitleI/Chapter270/Section6, ***NEW BUSINESSES AND NEW OWNERS ONLY*** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 G SIGNATURE.. - - PRINTED NAME: Laura Salvucci SR.LICENSING COORDINATOR.- DATE: 12 A0 /2020 Q:1Application FormsITOBACCO APP-NonFavor 12-18-19.docx 4 � E1 Town of Barnstable For Office Use Only: Initials: Ins Amt Pd$ " Inspectional Services Date Paid h Check# y9�B,A R BI ' Cash IMY 69. ,0� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS, MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT Cumberland Farms #2326 ESTABLISHMENT NAME (DB/A) S/B 395 W. MAIN ST ADDRESS OF BUSINESS ATTN: LEGAL DEPT. 165 Flanders Rd. Westborough Ma. 01581 MAILING ADDRESS (IF DIFFERENT FROM ABOVE) CUMBERLAND FARMS INC. OWNER'S NAME: LAST FIRST MIDDLE LSaivucci@cumberlandfarms.com 508-270-1504 EMAIL PHONE# FEDERAL ID# Do you currently possess a state license to sell tobacco products? Yes X No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form (provided herein).Signature ^-a� 'a)a /J zcz2 SR.LICENSING000RDINATOR Date 12/20/2020 C:'.Users`.decollik\ApPData`L.ocal\Nlicrosoit'+Windowsit'`et(:ache',Content.Outlook`,l'ZOF4E138\TOBACCO APP2019 dob.docx ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—&371-9. Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products, as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The following employee(s) received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: "6vl C�V 2 2l ZG Si a r Printed lime Date N jn A %03 1­�I)- Signature Printed Name Date ` �rchQei V�hrC Signature Printed Name Date d nil J/ kJam S 9g_- 2 l -- 0 gnaturi Printed Name Date Signature Printed Name Date iZ-ZZ�Z� Signs e Printed Name Date Id 112 gnature Priame Date C:ItJsers`decollik\AppDatri;t..ocftl\Microsoft\Windrn,sllNet(:"he'•ContentOutlook\Y7_QF=fit�g',:TOBACCO APP"019 dob,docx t trrggi �` rF Commonwealth of Massachusetts Letter ID:L15245(,7GIG Department of Revenue > > Notice Date:September 4.2020 Q' j Gcot'frcy E Snyder,Comniissioncr Account!D:CGL-10031037=486 OF� massxgovjdor RETAILER LICENSE FOR SALE OF CIGARETTES �r�I�r�rIII�IIrrNh'I����''��'I�rinr'�1111���1�'I�IIr�n�11111r - CUMBERLAND FARMS INC CUMBERLAND FARMS#0176 CUMBERLAND 165 FLANDERS RD - WESTBOROUGH MA 01581-1032 - Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.govlmasstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE ----------------------------------------------------------------------------------------------------------------------------------------------- �Qsy"c"(rs�r MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 s Retailer License for Sale of Cigarettes This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. CUMBERLAND FARMS INC Account ID: CGL-10031037-486 CUMBERLAND FARMS #2326 Location ID: 10031037-0531 395 W MAIN ST License Number: 1801275392 ` HYANNIS MA 02601-3644 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2020 Expiration Date: September 30,2022 �SKttn24 Commonwealth of Massachusetts Letter ID:L0635599424 Department of Rcvcnuc Notice Date:September 4,2026 . { L) Geoffrey E.Snyder.Commissioner Account ID:CR '-10031037.489' F\TCK� mass.govidor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO I �linu)llllli it llllllllli�lllllnllrlli11111'I"Illlli'I'lll CUMBERLAND FARMS INC CUMBERLAND FARMS#0176 CUMBERLAND 165 FLANDERS RD WE•STBOROU'GH MA 01581-1032 Attached below is your Retailer License for Sale of Cigars and Smoking Tobacco(Form CT-3T). Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.govlmasstaxconnect to view and re-print a copy of this license. If you have any questions about your license, call us at(617)887-6367 or toll-free in Massachusetts at (800)392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE MASSACHUSETTS.DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco ti-rOV This license must be posted and visible at all times. The sale of tobacco products to anyone under IS years of age is prohibited. CUMBERLAND FARMS INC Account ID: CRL-10031037-489 CUMBERLAND FARMS #2326 Location ID: 10031037-0729 395 W MAIN ST License Number: 1161795584 HYANNIS MA 02601-3644 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1, 2020 Expiration Date:September 30,2022 Commonwealth of Massachusetts Letter ID:L0798377536 Department of Revenue Notice Date:July 23.2020 ' Geoffrey E.Snyder,Commissioner Account ID:EDL-1003 1037-534 Eyrpe mass,govtdor LICENSE;FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS - iir���llrl��l '1111r1rilrrinlnl�f llulrllt�ullnrllrt� li CUMBERLAND FARMS INC CUMBERLAND FARMS#3531 165FLANDERS RD;.. WESTBOROUGH MA 0158.1.1032 Attached below is your Retailer License for Sale.of Electronic Nicotine Delivery Systems. Cut along the dotted line and display at your business location. At any time,you can log into your, MassTaxConnect account at mass.govltnasstaxconnect to view and re-print a'copy of this license. If you have any questions aboutyour license,call us at(617}887-63'67 or toll-free in Massachusetts at {800)392-6089, Monday through Friday, 8:30'a.m. to 4:30 pm. DETACH HERE `Nns� MASSACHUSETTS'DEPARTMENT OF REVENUE � s Retailer License for Sale of Electronic Nicotine Delivery Systems' This license must be posted and visible at all times. The sate of tobacco products to anyone under 21 years of age,'is prohibited. CUMBERLAND FARMS INC Account ID: EDL-10031037-534 CUMBERLAND FARMS #2326 Location ID: 10031037-1270'. 389 W MAIN ST License Number:2715443.2 HYANNIS MA 02601. This certifies that the taxpayer named.above is licensed under Chapter 64C`of the Massachusetts.' General Laws to sell electronic nicotine delivery systems at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. ' Effective''Date:July 23,'20210 Expiration Date: September 30,20.22 EA y,`p"F1N�E'i{pk� TOWN OF BARNSTABLE._ --. -, -. H OFFICE HOURSR'S Establishment Name: Date: Page: Of. !T BARNSfABLE.p� PUBLIC 0 MAN STREET 3:3030-4:30 P.M.DIVISION - .. - - e -s:30 n.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. ,a3v e 0 HYANNIS,MA 02601 508-862 asaa No Reference. R-Red Item : _ " PLEASE PRINT CLEARLY 'EDN1A� FOOD ESTABLISHMENT INSPECTION REPORT Name Daub Tyne of 6"" f Inspection Oneratiori(s) outin g Gt�+✓ G�- - A,- Address / � Risk F Service Re-inspection Y Level Reta GJ" Previous Inspection ���,,,��,� / ^�- Telephone esidential Kitchen Date: �� "K /S Cl�l Mobile- Pre-operation (! Owner HACCP Y/N Temporary Suspect Illness �� I �°tT✓f Caterer - General Complaint Person in Charge(PIC) �' W Time Bed&Breakfast HACCP In- so �.,` Inspector ��O V Out: ( v r Each violation checked re Tres an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ �., Violations marked may pose an imminent health hazard and require immediate corrective Tobacco . 560.009(F) ❑ .o 1ro Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Pr tion of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties L�1� HHandwash Facilities ✓J /� 1 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives !- ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME1TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures aCite, d ❑ 5.Receiving/Condition ❑ 17.Reheating - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling Aal i ` C �h �, J hUl- er ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding yj/ T PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control tcl �I ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ' ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11"Good Hygienic Practices ❑ 22.Posting of Consumer Advisories O V' ` i�1�� W Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) �� ❑ No Yes rw Corrective Action Required: Non-critical(N)violations must be corrected immediately or Overall RatingI within 90 days as determined by the Board of Health. . Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Sche ule ke ency Suspension C N Official Order for Correction:Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of.Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is,scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 g = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's i at re Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N ..�.. ._ ..-..-.-1� v r-... . a.-.�t .....:. i .. ..�.- ., - ..w..-_ �_�.r.v- �. _ ��..-._-._ �. � ._. _-.._.� _�.�-..-<- -.o ...-.._--.._.-....-.-..��.P-.��.-.i... ----T�.�. --- --• d .. - ... .ter..,e._ ..� .. ...._. -- a,w ..,_:..s. �. _.�_�-cam.�.._-` - ,.� Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 '- Person-in-Charge Duties � - 3-302:14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 7-102.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maihtained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* . 3-302.11(A) Food Protection* P g * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 4 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Re or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated ted or Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13" Fluid Milk-and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 1 501.111 Chemical Sanitization-Temp.,p14, 16 Prnpar Conking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22'.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed R2-401.11 Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition - - . Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 ' 'Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and riskfactors listed above,can befound in the 6 Tags/Records:Shellstock E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products p6-301.1] Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7HACCP Plans Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p ME Tpk, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: age: of _ ti OFFICE HOURS ° PUBLIC HEALTH DIVISION 8:00-9:30A.M. i BA E. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .67 `0� _ HYANNIS,MA 02601 M-8 -46 No Reference R-Red Item _ PLEASE PRINT CLEARLY �'°rEo•Ma+° 508-862-4644 FO ESTAB ISHMENT INSP TI N REPORT Name Date Typ e pe of Inspection Routine Addresslj(isk�w < Fo ervice - Re-inspection evel Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP 1" Other Inspector u ( `� Each violation checked requires an explanation o the narrative pa e(s)and a citation of specific provision(s)violated. v Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness. 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALSA AA ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ®_0 FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY El11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 'U Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) 3 'U Corrective Action Required: No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-in pection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4.non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot - 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address vio tions observed,7 to 8 Y of receipt non-cri 29.Special Requirements (590.009) Pni al viol ons. If 1 critical refrigeration. within 10 days t of this order. olatio 4 to 8npn-critical violati s=C 30.Other DATE OF RE-INSPECTION: Insp is "gnature O 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ' nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y - N Dumpster Screen? Y_N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) V FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) I Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients r 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* - 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and P * 4-501.117. Mantra]Warewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served" 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate Equipment ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * e erne 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f Shellfish* p 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Ho[Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsrh ld be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C . Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3 403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 W6-30I.11 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 � HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. I THE ror, TOWN OF BARNSTABLE .HEALTH INSPECTOR'S Establishment Name: MMAr4R,ffij4i,S Date: age: of q OFFICE HOURS -T`- p ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified p i639 s e� HYANNIS,MA 02601 MON.-FRI. No Reference. R-Red Item PLEASE PRINT CLEARLY 'FON1�` FOOD ESTABLISHMENT INSP 'CT N REPORT 508-862-4644 Name 00 Date of Type of Inspection b ' r ion"S Routine Address Risk ervi Re-inspection Level Retail Previous Inspection Telephone Resi ential Kitchen Date: Mobile Pre-operation nz- �.�IAII Owner HACCP Y/N Temporary Sus ss Caterer eneral Com r Person in Charge(PIC) Time Bed&Breakfast ACCP l Other Inspector u w � - Each violation checked requires an explanation on the narrative p e(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ j FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands r ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS v ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives i r' a n ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling - ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION'FROM CONTAMINATION ❑20.Time Asa Public Health Control A AA A QA ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories LD RJ 5.1 / Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations r, r Critical(C)violations marked must be corrected immediately. (blue&red items) 3)a Corrective Action Required. ❑ No Non-critical(N)violations must be corrected immediately or U J within 90 days as determined b the Board of Health. Overall Rating Voluntary Compliance y y ❑ ry p ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. F] ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4von-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If FC-6 59 C=2 critical violations and less than 9non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility . ( )( 0.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials .(FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-cril Ical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. 'b violation,4 to 8 non-critical viola ns-C. 30.Other DATE OF RE-INSPECTION: Ins• or Signature 9 I nt: 31.Dumpster screened from public view" Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N - / #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter.Posted . Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) JDemonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-]02.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 7-202.11 Restriction-Presence and 20 Use* Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)l Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and -- -- - 4-501.111 Manual Wazewashing-Ho[Water 7.206.1.2 Rodent Rait Ctationc * 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) 1 Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E1I°nee ririzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- ' * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 10 Proper,Adequate Handwashing g' P � Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Wild Mushrooms ( )( )ro) practices should be debited under#29-Special 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-001.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification g 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1'008 HACCP Plans 6-301.12 Hand Drying Provisio 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 690.000. �F�ME T TOWN OF BARNSTABLE, HEALTH INSFECTORs Establishment Name. �. Date: Page: of OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS -FRI. HYANNIS,MA 02601 MON. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-4644 � F OD ESTABLISHMENT INSPJECTION REPORT Name Date Tvne of T s ectio Operation(s) Routin Addres Risk F rvice spe ion 1 4, Level eta Previo e t Telephone dential Kitchen Date: IP Mobile Pre-op tinIF Owner HACCP YIN Temporary Suspect Illness 4 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector Each vinlatin'A checked requi s an"explana ion on t e narrativ page s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and isk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ ' FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories U / Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the i m Embargo Emergency Closure Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,.results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,.Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation F is scored automatically lack of no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and than 9 non-critical. If no critical ' water,sewage back-up,infestation tion of rodents or insects,or la 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted"to the Board of Health at the above address violations observed,7 too 8 8 non- tical vi lations. If 1 critical refrigeration. within 10 days of receipt of this order. vio n,4 to 8 non-critical vio ions 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: ctor' i tu 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's Si gnatur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y�_N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12" Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in=Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°17*. Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* p g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual WaTewashing-Hot.Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* -- Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective vusooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 4-702.11 Frequency r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165`F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145'17 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices _17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'17 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41`F/45°F Item Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. `�p7MF Tpk, TOWN OF BARNSTABLE. . HEALTH wsPECTOR's Establishment Name: Date: / ��/ l Page:. .( of 1 4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A 6;-e�0� HYANNIS, MA 02601 Mons.-FRI.rFo No Reference R-Red;Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name J �/ F�r(�15 Date i)�U/jq Tvoe of T e of Ins ec io - ; Operation(s) Ine Address `1�(�5 �f � ��! Risk ervice Re-7 ection I3� - Level tail Previous Inspection Han 7 r✓ WKJ Telephone -Residential Kitchen Date: Mobile. Pre-operation ^ Owner HACCP Y/N Temporary Suspect Illness 8 cit,�MoIM Bch 10 Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP l (Ic o f --oz(a ' In: Other ,/_ Inspector R (,� 4)�ras Out: .- � -!� r �cl v I 'EV&42, - e Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Red Items)� Anti-Choking 590.009(E) Interventions and Risk Factors V .� BOA ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ -c✓ Action as determined by the Board of Health. - Allergen Awareness 590.009(G) ❑ D v m 1`4. FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities L I ( I ( rS EMPLOYEE HEALTH PROTECTION FROM CHEMICALS r w&hL tyl,0, ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ED No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure. El Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation-and less than 4 non-critical violations regardless of the number of critical,results in an F.` 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 26.Water,Plumbing and Waste. (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical. If no critical ` water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to Snon-critical violations. If i critical refrigeration. Within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009 y P , 30.Other " DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view �`���i g(/17�S Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size .Variance.Letter Posted - Y N I Dumpster Screen? Y N Violations related to Foodborne Illness - - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-2Q2-12_ Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 � Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15- Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* uirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Re q 590.003(G) Reporting by Person in Charge* - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Re or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated ted or - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 AnimalConsu Fooer d That Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Elf°bve mnooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.ou Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and.Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Ho[Water and StuffingContaining Fish,Meat,Poultry or } 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 8 �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y * 12 Prevention of Contamination from Hands 3-403.11E Remainin Unsliced Portions of Beef Roasts* Critical and noncritical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the g Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 . HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 1 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback8-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r � Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BunvsrABLF, Paul J.Canniff,D.M.D. aIA . 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate D � Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 127 Issue Date: 12/10/2019 DBA: CUMBERLAND FARMS #2326 OWNER: CUMBERLAND FARMS,INC. Location of Establishment: 395 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: RETAIL FOOD Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Cr'� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: `X r of tqyFor OfficeInitials: Town of Barnstable _ Date Paid b BARNs.AB Inspectional Services I assq i639. Public Health Division QED MAy� Thomas McKean, Director lS7Y (21(C> 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: �(,t��r�y',�jiy> ��/JJS 02 ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �;__ST �p� E-MAIL ADDRESS: LSalvuccl@cumberlandfarms.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: iiu-fJ1?o TOTAL NUMBER OF BATHROOMS: 11 WELL WATER: YES_NO_/.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDES OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) _kIFOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE ta) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Applica[ion FormsTOODAPP 2020.doc i f F, Cumberland Farms, Inc. • Tax Department OWNER INFORMATION: 165 Flanders Rand FULL NAME OF APPLICANT Wesftrough. MA015431 c SOLE OWNER: YES/NO OWNER PHONE# ADDRESS_ <`u,.qb Farms, CORPORATE OWNER: Tax nppartment CORPORATE ADDRESS: F4 65 Flanders Road„ w PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Manaters Expiration Date Allergen Awareness Expiration Date 1. S,: �2/ /..2 lea! I.C�,-/w / ice. l 42- l 2. i SIGNATU OF AP"LICA T DATE ***FOOD POLICY INFORMATION* SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q:1Application FormsTOODAPP REV3-2019.doc r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. -UARN; rai8 Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 127 Issue Date: 1/1/2020 DBA: CUMBERLAND FARMS #2326 OWNER: CUMBERLAND FARMS,INC. Location of Establishment: 395 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual X Seasonal FEES II YEAR. 2 2 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, IRS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY f ; IME r Initials: .•ti ti Town of Barnstable Date Paid (4o Amt PdPd$!3?,S-✓ BARNgppgLE, : Inspectional Services. lj vnss. Check# 1 � � `l'AiEo039.,a`0 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION on-Flavored DATE NEW BUSINESS�� OWNERSHIPP RENEWAL NAME OF TOBACCO ESTABLISHMENT: ADDRESS OF TOBACCO ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Ra"p6r4ts E-MAIL ADDRESS: Walvucci@cumberlandtarms.com / 6115V7 TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: Ea MV - Oo?o2 7 OWNER'S NAME: (i31MbPi'I,arn'd Farm.0j JnCQWNER'S PH#jn�6.W_Z��. OWNER'S ADDRESS: Tax Department 165 Flanders a CORPORATE ADDRESSMeStborough, MA 01531 CORPORATE FID# 04-2 586 ANNUAL: SEASONAL: DATES OF OPERATION:_/ /_ TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: htti)s:Hmalegislature gov/Laws/GeneralLaxxs/PartIV/TitleI/Chapter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY *** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobac 4) Payment of Fee(s) -see page 4 SIGNATURE: PRINTED NAME: Richard Fournier Tax Manager DATE: w/ Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc Commonwealth of Massachusetts Letter ID:L0563905152 oa_ Department of Revenue Notice Date:September 18,2018 �' `i t g Christopher C.Harding,Commiss oncr Account ID:COL-10031037-486 dt� mass_govddor RETAILER LICENSE FOR SALE OF CIGARETTES IIIIIITI1-11116r1111111tltlIlll�ml�tllut1ii11tt�1�111u111t CUMBERLAND FARMS INC CUMBERLAND FARMS#0176 CUMBERLAND 165 FLANDERS RD WESTBOROUGH MA 01581-1032 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.govlmasstaxconnect to view and re-print a copy of this license. If you have any questions about your license, call us at(617)887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE --------------------------------------------------------------------------------------------------------------------------------------------- .f, MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T R * Retailer License for Sale of Cigarettes 7 'FtirOt This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. CUMBERLAND FARMS INC Account ID: CGL-10031037-486 CUMBERLAND FARMS#2326 Location ID: 10031037-0531 395 W MAIN ST License Number: 963463168 HYANNIS MA 02601-3644 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1, 2018 Expiration Date: September 30,2020 y` usF Commonwealth of Massachusetts M%M Later ID:L1391219328 �UT cP of Revenue Notice Qatc:September 17,2018 Christopher C.Harding,Commissioner Account ID:CRL-10031037-489 Department mass_govtdor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO �Ir��rlrll�4�lrirlll��ml1l�rt�lltlrlrtlut�ntlldrnrrtt�n�l CUMBERLAND FARMS INC CUMBERLAND FARMS#0176 CUMBERLAND 165 FLANDERS RD WESTBOROUGH MA 01581-1032 Attached below is your Retailer License for Sale of Cigars and Smoking Tobacco(Form CT-3T).Cut along the dotted line and display at your business location. At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617)887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE ----------------------------------------------------------------------------------------------------------------------------------- ,s�`tiusF� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco 'FivrOV This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. CUMBERLAND FARMS INC Account ID: CRL-10031037.489 CUMBERLAND FARMS#2326 Location ID: 10031037-0729 395 W MAIN ST License Number: 1904384000 HYANNIS MA 02601.3644 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date:October 1,2018 Expiration Date:September 30,2020 •eV r FEZ The Commonwealth of Massachusetts Department of Industrial Accidents v I Congress Street,Suite 100 Boston,MA 02114-2017 www atass.gov/dfa Workers'Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lggibly Business/Organization Name:Cumberland Farms Inc. Address: 165 Flanders Road City/State/Zip: Westborough,MA 01581 Phone#:508-270-1400 Are you an employer?Check the appropriate box: Business Type(required): 1.[Z] I am a employer with 3571 employees(full ands 5. Retail or part-time).* 6. Restaurant/Bar:;Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10 j]Manufacturing no employees.[No workers'comp.insurance required]* 4.❑ We are a non-profit organization,stafed by volunteers, I I.❑ Health Care with no employees.[No workers'comp,insurance req.] 12.❑Other *Any applicant that checks box#I must also till out the section below shoe ing their workers'compensation policy information, **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#I. I am an employer that is providing workers'compensation insurance for my employees Below is tine policy information. Insurance Company Name: ACE American Insurance Company Insurer's Address: 33 Arch Street,Suite 2900 City'State'Zip:._ Boston, MA 02110 Policy#or Self-ins.Lie.0 SCFC65896382 Expiration Date:04/01/2020 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance c verification. I do hereby certify,under re Pat ald$1 of perjury float the information provided abovj is truiland correct. Sl nature: Date: glione#:508-270-1443 Ojjicial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass gow'dia r CPTtA4B L I SSHMENT'S NAME TOBACCO SALES Employee Si natu �v � Signature Form e This form is for official use to indicate that the employees)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one(21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Sales to Minors—&371-9.Sale and Distribution of Tobacco Products 1. No person shall sell or provide s tobacco product,as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of t Health Pro 'bition o Smoking Regulation �and Chapter 270 Section 6 of the Massachusetts General Laws: al0(0 . Signature U Printed a Date • ` &.d cage/Q.;/I It-ay` /9 Signature Printed Name Date Si store � Punted Name Date f 600- -A ) Signature Printed Name We Signature- Printea Name Date aature Printed Name *f -Date Aided .!-qr4 lei, ignaturePrinted Name , bate ff i Z l 13 19 Q 1APPIiciition P• n v r l - - 9.doc �1r�;1ia nc, la i3 ri q d `79W 1146 a ' Scanned with CamScanner ESTABLISHMENT'S NAME' TOBACCO SALES Employee Signature Form "This form is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one(21). Below is Section 371-9.of the Town of Barnstable Board of Health Regulation: Sales to Minors-&371-9.Sale and Distribution of Tobacco Products. L No person shall sell or provide a tobacco product,as defined herein,to person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products,as defined herein, shall verify the age of the purchaser by'means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The employee(s)below received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws: &-a. jy /9 Signattifie PrintedVarne Date C Alca (3_0.xz_x Si lure p Printed Name Date 1.141 u) IF (� cure Printed Name Date Ain- Si azure Printed Name Date Signature Printed Name Date Sign-lure Printed Name Date ' afore Printed n � Date Q:1Application FormATOBACCO APP.NonFavor 11-21-19.doc x Scanned with CamScanner 1 Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. DARNSTABLE. John T. Norman 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 127 Issue Date: 12/20/18 DBA: CUMBERLAND FARMS #2326 OWNER: CUMBERLAND FARMS,INC. Location of Establishment: 395 WEST MAIN STREET HYANNIS, MA 02601 Type of Business Permit: RETAIL FOOD Annual: . YES Seasonal: IncloorSeating: 0 OutcloorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - -- ---------- - MOBILE-FOOD: MOBILE-ICE CREAM: Ga� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: a FIKE For 9fi • Initials: o„ Town of Barnstable • Date Paid Amt Pd$ M MA99. 9 MASK�$ Inspectional Services i639 `0 Check# 7 AIFo ° Public Health Division ' emu:, Thomas McKean, Director 200 Main Street, Hyannis, A 02601 d ' I l� � c M Office: 508-862-4644 Fax: 508-790-6304 '' r o`1 APPLICATION FOR PERMIT TO OPERATE A/FOOD ESTABLISHMENT DATE (1 20 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Cwber lan d Flir m S # 2 2.(p ADDRESS OF FOOD ESTABLISHMENT: _395 W. Main 6t. IiI Qnnis MA 0)-(p01 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): i LP 5 Fl a I'i d e,r.S E d. t` ebtbonw* NA 01581 E-MAILADDRESS: LSoNacd C, cumbedGind-Farms . c.om TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 19-Q21 TOTAL NUMBER OF BATHROO S: Z WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:�_ SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: _0 OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIIIED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc --- - ---- PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT Cumberland Farms, Inc Tnx [),cp 1Y-F en+ SOLE OWNER: YES/NO OWNER PHONE #_ (5 ojo )--1 O- 150 1- ADDRESS_ IL25 Flande1(, f?d . bcO—rouAl'l , MA OIS8I CORPORATE OWNEOa1nn_rIQ,✓1cQ FO�trWISIIIaRALIDNO. : ()y - 2?) }358(v CORPORATE ADDRESS: I lP 5 Flanders Ed, W e A bo ro u G h NA D 1581 PERSON IN CHARGE OF DAILY OPERATIONS: ev S List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date • en Awareness Ex iration Date ,Ms 1� 1 �aa�► I. ti20a-1 Q0,jKe( SIGNAT O APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to openinz!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/bealthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. I NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPPREV2018.doc Town of Barnstable Regulatory Services Department �. 59. Public Health Division r;6;q. a�0 FD1Y'ps 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION ; 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT Cumbericind Farms 'Inc. LAST NAME OF APPLICANT FIRST NAME MIDDLE INITIAL Cumlo-erland Farms 4 23z1p DB/A 395 W - MCAM S-t. HUgnniS, MA 02-U01 r STREET ADDRESS 505 -Iqo - 0221 -IB4358LP TEL PH NE # FID# Do you currently possess a state license to sell tobacco products? Yes .,/ No Each employee who sells tobacco products must receive and understand the Sections VII b. and VII c. of the Board of Health Prohibition of Smoking Regulation, (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided-on the next page . E h employee who sells tobacco products must sign the Employee ignatur For (pr ided herein). Signature Date Q:\Application Forms\TOBACCO APP2018 dob.docx Town _of-Barnstable For Office Use Only: Initials: Date Paid Amt Pd$ Inspectional Services check# casn �.R"NSTA Public Health Division s639 �0 A 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT ESTABLISHMENT NAME (DB/A) ADDRESS OF BUSINESS vl 5— MAILING ADDRESS (IF DIFFERENT FROM ABOVE) ,/ hG 2 S OWNER'S NAME: LAST FIRST MIDDLE WaNucci@cumberlandtarmstam 04-2843586 EMAIL PHONE# FEDERAL ID# Do you curren possess a state license to sell tobacco products? Yes No . f Each employee who sells tobacco products must receive and understand.Chapter 371 of the Town of Barnstable Code (copy provided herein)and the Massachusetts General Law Chapter 270, Section 6.00 (a copy provided on the next page). Each employee who sells tobacco products must s'gn a Employee Signature Form (provided herein). Signature Date Richard Fournier Q:\Application Forms\TOBACCO APP2019 do docx Tax Manager """'""`""•."""'°"_"�,11'1itfL'iJYLMEl\T'SNlAl�'YL._...., _. -- .- _ TOBACCO SALES Em to ee Signature Form p yk Ibis drr�i is nd for official u� to ihdicate that the table Case Hind Chestablishment p b1270 Section received6 the understood Chapte- 37l `the Town' of erns } �sachnsetts General.1��vs."which describes the penalties for selling and/or giving tobacco pm acts to Ahy.P n.'und.. ` of#wenty-one{21). Below is Section 37I-9. of the Town of ble Baaid of HOOtl Regulation: Sate and Dcsfribulot�of To}1acco:Products. estta moors 371- . 11 rt vide a=tobacco,prvd%4 as defined herein,to a person under l'.. No pexsoz�shad se- p `Themii�i��m,lega sales age, hemii thum legal{sales age in the Town of Barnstable is 21,years of age: ng tobacco; _ products,as defined herein, , 2, Identification= each perm setlrig tix dcsb of a vlicl go esrinent-issued photographic shall verily the age.of thepurchaser by m purchaser is 21 years old or identifcatian�conWning the bearer's date of birth that fie older. Verification" required.f�r any person under,the age of 27. 371'9of th } received and'underst©od.Section e Town of Barnstable The following emp o�►ee(s}, Board of Health Prohibition of Smoking Regulation and Chapter.270 Section b of the Massachusetts-General haws: _, . .. Painted a Date Signature 5; Printed Name Date _ inafure Sigplywo PdritedName Tate bt-1 rr f ature Ffinted Name sate: .,. . Signature Printed Name Data S" a ,t--�— Printed I�arne� Signature rrim ed Name Date, W40 q Appiicadon FormstTOBACCO APP2019 dob.doex "A' . W 7. M1 ., TOD AM lb 6-mPlow(g) m oat:27 - i. ` E� � � = � � 6A � �"`=£ Of �5 Iftzv TO n ." n DO pru "toe I law, W, Woven Al � $ ,� a '�. - `� jw fir " _ - c k Al god ivor Al V ,� t. o All Alf IQ -] 4 0, gr '" lee ,_ N 'R CUMBERLAND FARMS 395 MAIN STREET HYANNIS PLANS ARE IN ATTIC: BOX# 3 TALL PLANS Plans Rev. 9/9/15 & 9/30/15 Cumberland F A R M S W V Z G7 TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 MAIN STREET - HYANNIS, MA 02601 October 24, 2016 Dear Valued Supplier: We are moving! Please note that, effective as of December 1, 2016,the corporate headquarters of Cumberland Farms, Inc. will be: 165 Flanders Road Westborough, MA 01581 Our fax and telephone numbers will remain unchanged. Kindly update your records accordingly. Cumberland Farms, Inc. 100 Crossing Boulevard, Framingham, MA 01702 508-270-1400 www.cumberlandfarms.com KLE/NFELOER (000 Bright People.Right Solutions. C CA Electronic Submittal July 27, 2016 Massachusetts Department of Environmental Protection w Southeast Regional Office Bureau of Waste Site Cleanup 20 Riverside Drive Lakeville, MA 02347 Re: Release Abatement Measure (RAM) Plan Property#V099.0(Station#2142) 395 West Main Street Hyannis, Massachusetts RTN 4-14257 Tier 1 C Permit#W007791 To Whom It May Concern: - On behalf of Cumberland Farms, Inc. (CFI), attached please find the RAM Plan and completed transmittal form BWSC-106 for the above referenced site. This report has been prepared in accordance with the provisions set forth in 3.10 CMR 40.0444 of the Massachusetts Contingency Plan. The purpose and objectives of the herein-proposed RAM are to excavate, appropriately manage,and to the degree required, transport and dispose of soil and groundwater potentially affected by Oil and or Hazardous Materials during planned construction activities. The CFI contact for this site is Mr. Matthew Young. Correspondence should be sent to Mr. Young's attention at Cumberland Farms, Business Support Campus, 100 Crossing Boulevard, Framingham, MA. Mr. Bruce C. Ross, Licensed Site Professional (LSP#4284), of Kleinfelder, has:supervised the preparation of this report. Additionally,should you require any further information or have any questions relative to this submittal, please do not hesitate to contact either of the undersigned at(508)370-8256. Sincerely, KLEINFELDER ov Emily M.Straley, Bruce C. Ross, LSP Project Manager Senior Project Manager Cc: Matthew Young, CFI (electronic submittal) Thomas McKean, Director; Town of Barnstable Board of Health, 200 Main Street,Hyannis, MA 02601 Mark S. Ellis,Barnstable Town Manager, 367 Main Street, Hyannis, MA 02601 20162042.004A/FRM16R44195 RAM Plan 7-16 1 Speen Street, Suite 200, Framingham, MA 01701 p 1508.370.8256 f 508.628.1401 Massachusetts:Department of Environmental Protection BWSC 106 Bureau of Waste Site Cleanup ' RELEASE ABATEMENT MEASURE Release Tracking Number TRANSMITTAL FORM - 14257 Pursuant to 310 CMR 40.0444- 0446(Subpart D) IA:SITE LOCATION: 1.Site Name/Location Aid: CUMBERLAND FARMS s 2`Street Address: 395 WEST MAIN ST 3.City/Town: HYANNIS 4.Zip Code: 026010000 r 5.Check here if the disposal site that is the source of the release is Tier Classified.Check the current Tier Classification Category. r:a.Tier I r b.Tier ID ❑c.Tier II B.THIS FORM IS BEING USED TO:{check all that apply) 1.List Submittal Date of Initial RAM Plan(if previously submitted):. . (imn/dd/yyyy) F.2.Submit an Initial Release Abatement Measure(RAM)Plan. R a.Check here if the RAM is being conducted as part of the-construction of a permanent structure.If checked,you must specify what type of permanent structure is to be erected in or in the immediate vicinity of the area where the RAM is to be conducted. . b. Specify type of permanent structure:(check all that apply) r i.School u.Residential ,, m.Commercial fJ iv.Industrial ❑v.Other Specify: i 1 3.Submit a Modified RAM Plan of a previously submitted RAM Plan. C 4.Submit a RAM Status Report. I 5.Submit a Remedial Monitoring Report.(This report can only be submitted through eDEP,concurrent with a RANI Status Report.) a.Type of Report:(check one) i.Initial Report r ii.Interim Report r iii.Final Report b.Frequency of Submittal: r i.A Remedial Monitoring Report(s)submitted every six months,concurrent with a RAM Status Report. (i ii.A Remedial Monitoring.Report(s)submitted annually,concurrent with a RAM Status Report. c.Number of Remedial Systems and/or Monitoring Programs: A separate BWSCI06A,RAM Remedial Monitoring Report,must be filled out for each Remedial System and/or.Monitoring Program addressed by this transmittal form. 6.Submit a RAM Completion Statement. C17.Submit a Revised RAM Completion Statement. 8.Provide Additional RTNs: r a.Check here if this RAM Submittal covers additional Release Tracking Numbers(RTNs).RTNs that have been previously linked to a Primary Tier Classified RTN do not need to be listed here.This section is intended to allow a RAM to cover more than one unclassified RTN and not show permanent linkage to a P-mary Tier Classified RTN. b.Provide the additional Release Tracking Number(s) �- covered by this RAM Submittal. r 9.Include.in the RAM Plan or Modified RAM Plan a Plan for the Application of Remedial Additives near a sensitive receptor, pursuant to 310 CMR 40.0046(3): (All sections of this transmittal form must be filled out unless otherwise noted above) Revised: 8/5/2013 Page 1 of 6 L71Massachusetts Department of Environmental Protection BWSC 106 Bureau of Waste Site Cleanup RELEASE ABATEMENT MEASURE(RAM) Release.Tracking Number TRANSMITTAL FORM - 14257 Pursuant to 310 CMR 40.0444- 0446(Subpart D) C.RELEASE OR THREAT OF RELEASE CONDITIONS THAT WARRANT RAM: 1.Media Impacted and Receptors Affected:(check all that apply) r a.Paved Surface r b.Basement r c.School r1.d.Public Water Supply e.Surface Water f.Zone 2 (_.1 g.Private Well r h.Residence r i.Soil F j.Ground Water D k.Sediments r 1.Wetland r in.Storm Drain r n.Indoor Air r o.Air (J p.Soil Gas r]q. Sub-Slab Soil Gas ❑r.Critical Exposure Pathway f. l s.NAPL r t.Unknown r u.Others Specify: 2.Sources of the Release or TOR:(check all that apply) r a.Transformer r b.Fuel Tank r c.Pipe r d.OHM Delivery r e.AST rl f.Drums E g.Tanker Truck r h.Hose r i.Line Ri j.UST Describe: Tank r k.Vehicle !_J 1.Boat/Vessel r in.Unknown r n.Other. 3.Type of Release or TOR:(check all that apply) r a.Dumping r b.Fire 01 c.AST Removal ❑d.Overfill r e.Rupture r[f.Vehicle Accident r'g.Leak C h.Spill r i.Test Failure F—i j.TOR Only r k.UST Removal Describe r 1.Unknown r in.Other: 4.Identify:Oils and Hazardous Materials Released:(check all that apply) r a.Oils r b.Chlorinated Solvents r c.Heavy r d.Others Specify; Metals D.DESCRIPTION OF RESPONSE ACTIONS: (check all that apply,for volumes list cumulative amounts) r 1.Assessment and/or Monitoring Only [712.Temporary Covers or Caps r 3.Deployment of Absorbent or Containment Materials r 4.Temporary Water Supplies r 5.Structure Venting.System/HVAC Modification System r 6.Temporary Evacuation or Relocation of Residents r 7.Product or NAPL Recovery r 8.Fencing and Sign Posting rE 9.Groundwater Treatment Systems r 10.Soil Vapor Extraction r 11.Remedial Additives 0112.Air Sparging LJ 13.Active Exposure Pathway Mitigation System r 14.Passive Exposure Pathway Mitigation System r 15.Monitored Natural Attenuation r 16.In-Situ Chemical Oxidation Revised:8/5/2013 Page 2 of 6 Massachusetts Department of Environmental Protection BWSC 106 Bureau of Waste Site Cleanup RELEASE ABATEMENT MEASURE WA1Vi) Release Tracking Number TRANSMITTAL FORM - 14257 Pursuant to 310 CMR 40.0444- 0446(Subpart D) D.DES.CRIPTION OF RESPONSE ACTIONS(cont.): (check all that apply,for volumes list cumulative amounts) R 17.Excavation of Contaminated Soils F a.Re-use,Recycling or Treatment F--i i.On Site Estimated volume in cubic yards Fill ii.Off Site Estimated volume in cubic yards 1000 iia.Receiving Facility: TBD Town: TBD State: MA iib.Receiving Facility: Town: State: iii.Describe: UP TO 1,000 CY OF SOIL MAYBE REMOVED DURING SITE REDEVELOPMENT ACTIVITIES b.Store F__j i.On Site Estimated volume in cubic yards ii.Off Site. Estimated volume in cubic yards iia.Receiving Facility: Town: State: iib.Receiving Facility: Town: State: FI c.Landfill ❑i.Cover Estimated volume in cubic yards Receiving Facility: Town: State: ii.Disposal Estimated volume in cubic yards Receiving Facility: Town: State: Cl 18.Removal of Drums,Tanks or Containers: a.Describe Quantity and Amount: b.Receiving Facility: Town: State: c.Receiving Facility: Town: State: 19.Removal of Other Contaminated Media: a.Specify Type and Volume: b.Receiving Facility: Town: State:. c.Receiving Facility; Town: State:. r 20.Other Response Actions: Describe: F.J.21.Use of Innovative Technologies: Describe: Revised: 8/5/2013 Page 3 of 6 L71Massachusetts Department of Environmental Protection BWSC 106 Bureau of Waste Site Cleanup RELEASE ABATEMENT MEASURE W Vvl) Release Tracking Number TRANSNUTTAL FORM 4� - 14257 Pursuant to 310 CMR 40.0444- 0446(Subpart D) E.LSP SIGNATURE AND STAMP : I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form,including any and all documents accompanying this submittal.In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and 309 CMR 4.03(2),and(iii)the provisions of 309 CMR 4.03(3), to the best of my knowledge,information and belief, >if Section B of this form indicates that a Release Abatement Measure Plan is being submitted, the response action(s)that is(are)the subject of this submittal(i)has(have)been developed in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000, (ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(iii)comply(ies)with the identified provisions of all orders,permits,and approvals identified in this submittal; > if Section B of this form indicates that a Release Abatement Measure Status Report and/or Remedial Monitoring Report is being submitted,the response action(s)that is(are).the subject of this submittal(i)is(are)being implemented in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set.forth in the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(iii)comply(ies)with the identified provisions of all orders,permits,and approvals identified in this submittal; if Section B of this form indicates that a Release Abatement Measure Completion Statement is being submitted,the response action(s) that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21E and-3 10 CMR 40.0000 and(iii)comply(ies)with the identified provisions of all orders, permits,and approvals identified in this submittal; I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false,inaccurate or materially incomplete. 1..LSP#: 4284 2.First Name: BRUCE C 3.Last Name: ROSS 4.Telephone; .. 508-370-8256 5.Ext.: 566 6.Email: bross@kleinfelder.com 7.Signature: BRUCE C ROSS 8.Date: 7/27/2016 9.LSP Stamp: �{ 1 (lnin/dd/yyyy) Eleanrc 17-1 Sea Revised: 8/5/2013 Page 4 of 6 Massachusetts Department of Environmental Protection: gWSC 106 Bureau of Waste Site Cleanup RELEASE ABATEMENT MEASURE OL VI) Release Tracking Number TRANSMITTAL FORM 0 - 14257 Pursuant to 310 CMR 40.0444- 0446(Subpart D) F.PERSON UNDERTAKING RAM: 1.Check all that apply: in a.change in contact name F b.change of address Cl c.change in the person undertaking response actions 2.Name of Organization: CUMBERLAND FARMS INC 3.Contact First Name: MATTHEW D 4.Last Name: YOUNG 5.Street: 100 CROSSING BLVD 6.Title: SENIOR PROJECT MANAGER 7.City/Town: FRAMINGHAM 8.State: MA 9.ZIP Code: 017025401 10.Telephone: 508-270-1400 11.Ext.: 4477 12.Email: " MYoung@cumberlandgul G.RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING RAM: 0 Check here to change.relationship R 1.RP or PRPR a.Owner b.Operator. c.Generator rJ d.Transporter EJ e:Other RP or PRP Specify: F-1 2.Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) r 3.Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) 4..Any Other Person Undertaking RAM Specify Relationship: H.REQUIRED ATTACHMENT AND SUBMITTALS: 1.Check here if any Rem ediation Waste,generated as a result of this RAM,will be stored,treated,managed,recycled or reused at " the site following submission of the RAM Completion Statement.You must submit a Phase IV Remedy Implementation Plan along with the appropriate transmittal form(BWSC108). r 2.Check here if the Response Actions)on which this opinion"is based,if any,are(were)subject to any order(s),permit(s)"and/or" approval(s)issued by DEP or EPA.If the box is checked,you MUST attach a statement identifying the applicable provisions"thereof." . r 3.Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the implementation of a Release Abatement Measure. 1714.Check here if any non-upd"atable information provided on.-his:form is incorrect,e.g..Release Address/Location Aid:Send corrections to bwsc.edep@state.ma.us. 5.If a RAM Compliance.Fee is required for this RAM,check here to certify that a RAM Compliance Fee was submitted to DEP,P.O. Box 4062,Boston,MA 02211. Ri 6.Check here to certify that the LSP"Opinion containing the material facts,data,and other information is attached. " i Revised: 8/5/2013 Page 5 of 6 Massachusetts Department of Environmental Protection BWSC 106 Bureau of Waste Site Cleanup RELEASE ABATEMENT MEASURE(RAM) Release.Tracking Number TRANSMITTAL FORM - 14257 Pursuant to 310 CMR 40.0444- 0446(Subpart D) I.CERTIFICATION OF PERSON UNDERTAKING RAM: 1.I,MATTHEW D.YOUNG attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal,including any and all documents accompanying this transmittal form,(ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained.in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii)that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. 1/the person or entity on whose behalf this submittal is made am/is aware that there are significant penalties,including,but not limited to,possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. 2.By: MATTHEW D.YOUNG 3.Title: SENIOR PROJECT MANAGER (Signature) 4.For: CUMBERLAND FARMS INC 5.Date: 7/28/2016 (Name of person or entity recorded in Section F) (mm/dd/yyyy) r 6.Check here if the address of the person providing certification is different from address recorded in Section F. 7.Street: 8.City/Town: 9.State: 10.ZIP Code: 11.Telephone: 12.Ext.: 13.Email: YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO$10,000 PER BILLABLE YEAR FOR THIS DISPOSAL SITE.YOU MUST LEGIBLY COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE.IF YOU SUBMIT AN INCOMPLETE FORM, YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE I Date Stamp(DEP USE ONLY:) Received by DEP on 7/28/2016 8:49:32 AM i Revised: 8/5/2013 Page 6 of 6 KLE/NFELDER Bright People.Right Solutions. RELEASE ABATEMENT MEASURE PLAN CUMBERLAND FARMS PROPERTY#V0990 (STATION #2142) 395 WEST MAIN STREET HYANNIS, MASSACHUSETTS I RELEASE TRACKING NUMBER 4-14257 I I I I July 2016 Kleinfelder 1 Speen Street, Suite 200 Framingham, MA,01701 (508) 370-8256 1 Speen Street, Suite 200, Framingham, MA 01701 p 508.370.8256 f 508.628.1401 KLEIN-ELDER Bright People.light Solu7onr. A Report Prepared for: Cumberland Gulf Group of Companies 100 Crossing Boulevard Framingham, Massachusetts 01702 RELEASE ABATEMENT MEASURE PLAN CUMBERLAND FARMS PROPERTY#V0990 (STATION #2142) 395 WEST MAIN STREET HYANNIS, MASSACHUSETTS RELEASE TRACKING NUMBER 4-14257 Prepared by: 4 .0 Samantha L.Slater, PG Project.Geologist Reviewed by; Emily M. Straley Project Manager Bruce C. Ross, CPG, LSP Senior Project Manager Kleinfelder 1 Speen Street, Suite 200 Framingham, Massachusetts 01701 (508) 370-8256 20162042/FRM16R44195 Page ii of iv July 27, 2016 TABLE OF CONTENTS LIST OF APPENDICES..............................................................................................................IV 1.0 INTRODUCTION..i.ii......6...............................................................I.,................................. 1.1 Site Description...................I........................... ................................................... 1.2 Site History:................................................... ........ .......................... ...................2 2.0 RELEASE ABATEMENT MEASURE PLAN.............. ........... .........................................3 . 2.1 . . Purpose and Objectives of the RAM ........... .........................................................3 2.2 Scope of Work.. .............................................................I..........................................3 2.2.1 Excavation of Soil.....................................................................................3 2.2.2 Soil Screening and Sampling..._. ............ ......:.....................................4 2.2.3 Groundwater Dewatering..........................................................................4 2.2.4 Backfilling..................................................................................................4 2.2.5 Monitoring Wells........................................................................................4 2.2.6 Wanagement of Waste ........................ ....................................................5 2.2.7 RAM Implementation Schedule...................................................................5 3.0 PERMITTING........................................................................................................ ..........6 4.9, FINANCIAL ASSURANCE................................................................................................ 5.0 REFERENCES..... ......... ................... ..................................................................... 8 6.0 LIMITATIONS ................................................................................................................. 20162042/FRM16R44195 Page iii of iv July 27, 2016 (ZLEHVFELDER Bnghri pm.Fight Saw- LIST OF APPENDICES Figures 1 —Site Locus 2—Site Plan i i 20162042/FRM16R44195 Page iv of iv July 27, 2016 KLE//VFELOER Bright Beopie.Bight SolothwiL .. 1.0 INTRODUCTION Kleinfelder is.submitting this Release Abatement Measure (RAM) Plan on behalf of Cumberland Farms, Inc. (CFI), and in accordance with the requirements of the Massachusetts Contingency Plan(MCP) 310 CMR 40.0444 for CFI Property#V0990 (Station #2142) 395 West Main Street in Hyannis, Massachusetts, hereafter referred to as the "subject property". The specific area III affected by the release associated with RTN 4-14257 is hereafter referred to as"the site Please refer to Figures 1 and 2 for a depiction of the subject property and surrounding area. CFI is the current owner of the subject location and the CFI contact for this site is Mr. Matthew Young. Correspondence should be sent to Mr.Young's attention at Cumberland Farms, Business Support Campus, 100 Crossing Boulevard, Framingham, Massachusetts 01702. 1.1 Site Description The subject property is a 0.60 acre parcel of land located at.395 West Main Street in Hyannis, Massachusetts. The property is improved with one single-story building divided into three commercial rental units, and a second single-story building located between the pump islands that operates as a convenience store. There are three.gasoline underground storage tanks (USTs; two. 12,000-gallon capacity and one 8,000-gallon capacity) located southwest of the convenience store, and two dispenser islands located east and west of the store. The site, where residual petroleum has come to be located.as a result of release(s)associated with RTN 4-14257, includes the CFI subject property, the residential :property located at 18-20 Suomi Road; the commercial property located at 379 West Main Street, and a portion of the Suomi Road right-of- way. Refer to Figure 1 for the regional location and Figure 2 for pertinent site features and sampling locations. According to the Massachusetts Department of Environmental Protection (MassDEP) Priority Resource Map, the site is located in a MassDEP-Approved Zone II Area, a Medium Yield Aquifer, and a Sole Source Aquifer(Cape Cod Aquifer), but is not located within a MassDEP Zone A of a Class A water body or an.Interim Wellhead Protection Area. According to the Hyannis Water Department, the subject property is located within a municipal Aquifer Protection District, specifically a Wellhead Protection Overlay Zoning District. The closest municipal water supply wells are 4020004-01G and 4020004-12G located approximately 1,531feet and 1,742 feet south of the site. Based on historical records, there are no private wells located within 500 feet of the site. 20162042/FRM16R44195 Page 1 of 0 July 27, 2016 KLEI FELDER BrightPmpte Rights Iutio s& The site is located approximately 900 feet north of freshwater wetlands. The site is not located within an area designated as State, Federal, or Municipal Protected Open Space,within a Natural Heritage and Endangered Species Program wetland habitat or an Area of Critical Environmental Concern. Fawcett's Pond is located approximately 1,800 feet east of the site and an un-named pond is located approximately 670 feet south of the site. 1.2 Site History In October 1998, MassDEP issued RTN 4-14257 to a 72-hour reporting condition triggered during the upgrade of the gasoline dispensers and product piping at the facility.Approximately 200 cubic yards of visually affected soil were removed during this upgrade. In 2002, MassDEP issued RTN 4-17412 to a 72-hour reporting condition triggered by the discovery of.0.65 inches of light non- aqueous phase, liquid (LNAPL) in monitoring well MW-7 during an Air Sparge/Soil Vapor Extraction(AS/SVE) pilot test. RTN 4-17412 and.RTN,4-14257 were linked and response actions associated with RTN 4-17412.have been conducted under RTN 4-14257. In January 2003, a Phase III Remedial Action Plan Addendum was submitted which summarized pilot test results and identified AS/SVE as the selected remedial action.. In May 2003, a Phase IV Remedy Implementation Plan was submitted which outlined the design and timeline to install an AS/SVE system. In January 2004, the AS/SVE system became operational. A Revised Phase IV - As-Built, Phase IV Final Inspection Report, and Remedy Operation Status Opinion was submitted in February. 2004. In July 2009, the AS/SVE remedial system was shut down as a result of diminished mass removal efficiency. In July 2010, a Class C-1 Response Action Outcome (RAO)was submitted,which concluded that AS/SVE was no longer an effective remediation method, and that the new selected remedy was post-remedial groundwater monitoring and natural attenuation as a temporary solution. 20162042/FRM 1 6R44195 Page 2 of 9 July 27, 2016 KLE/NFELOER Bright People.Right Solutlo 2.0 RELEASE ABATEMENT MEASURE PLAN 2.1 Purpose and Objectives of the RAM The subject property is scheduled to undergo redevelopment activities which will include the demolition of the existing structures at the site, including the convenience store, rental building, and canopy, followed by the construction of a 4,380-square foot convenience store building, three product dispensers, a dispenser canopy, as well as the installation of new site drainage features and upgraded product piping. The existing USTs are to remain in place. As part of these redevelopment activities, it is anticipated that excavation and soil intrusive activities Will be conducted over approximately the entire property. If identified, petroleum-affected media = interpreted to be associated with RTN 4-14257 will be removed for offsite disposal, or reused onsite where feasible and practicable. Please refer to Figure 2 for the locations of the existing structures. Based on the plans developed by Prime Engineering, Inc., the proposed grade changes are less than five feet. The purpose and objectives of the herein-proposed RAM are to excavate, appropriately manage, and to the degree required, transport and dispose of petroleum-affected soil and groundwater (if encountered) during the planned construction work associated with site redevelopment. During the course of this planned excavation work, if release conditions are encountered that are interpreted to be inconsistent with the gasoline release associated with RTN 4-14257, notification will be made to MassDEP in accordance with the applicable requirements of 310 CMR 40.0310. Additionally, should conditions associated with RTN 4-14257 be encountered that require IRA activities outside the scope of currently approved IRA work, MassDEP will be notified and work will be suspended pending verbal approval to amend the.IRA work scope accordingly. 2.2 Scope of Work 2.2.1 Excavation of Soil Kleinfelder will observe the soil excavation activities and staging of potentially affected soil at the site. Specific: areas of anticipated soul excavation are in the area of the proposed building foundation, proposed:site drainage features, and proposed canopy footings. Soil excavation will also be conducted for site grading purposes and for the installation of new product piping. Excavated soil will be direct-loaded into trucks for off-site disposal, temporarily stockpiled on-site for disposal off-site at a later time, or stockpiled for reuse on-site, as deemed appropriate based on the type and nature of soils disturbed. 20162042/FRM16R44195 Page 3 of 9 July 27, 2016 1 KLE/NFELDER Bright people.Fight Solutions. 2.2.2 Soil Screening and Sampling While observing the excavation, Kleinfelder will periodically screen soil by the jar headspace method using a photoionization detector(PID)and visual observation.Soil exhibiting PID readings over 50 parts per million by volume (ppmv) or that exhibits apparent petroleum staining will be segregated and stockpiled separately. Soil will be stored on and covered with polyethylene sheeting pending transport off site at the discretion of the Licensed Site Professional. Soil exhibiting PID readings under 50 ppmv and no visual evidence of petroleum affect may be stockpiled separately and re-used on site. 2.2.3 Groundwater Dewatering Based on the.depth to water at the subject property(15-20 feet below ground surface), it is unlikely that groundwater will be encountered during construction activities. In the event that it is necessary to remove potentially petroleum-affected groundwater from the excavated area, the groundwater will be pumped into anon-site storage tank. Water stored in the storage tank will be pumped from the storage tank utilizing a tanker truck for transportation and disposal under the appropriate.regulations and at an approved facility. 2.2.4 Backfilling Excavations will be backfilled with native material, soil reused from another location, or suitable fill material purchased from an outside vendor. Any soil brought to the site for use as backfill must be of similar or better quality with respect to the presence of OHM. In the event that soil is transported from another MCP-listed site, documentation must be provided demonstrating that the soil has been adequately tested and characterized before. reuse at the subject site. Likewise, potential excess soil from the subject property may be used offsite as backfill if it is of similar or better quality with respect to OHM, and if documentation is provided demonstrating that the soil has been adequately tested and characterized. Excavation locations will be finished at grade with concrete, asphalt or landscaping, as appropriate. 2.2.5 Monitoring Wells While efforts will be made to maintain the existing monitoring well network throughout the proposed site upgrade activities, it is possible that some existing groundwater monitoring-wells will be destroyed during excavation. CFI will evaluate site conditions after site redevelopment to determine if the destroyed monitoring wells will be replaced. Monitoring well replacement, if necessary, will 20162042/FRM16R44195 Page 4 of 9 July 27, 2016 KLE/NFELOER �Bright People.Right Solution. be conducted under subsequent response actions and are not considered to be under the scope of this RAM Plan. 2.2.6 Management of Waste Soil requiring off-site disposal will be transported to .a landfill or soil recycling facility for asphalt - batching or thermal desorption using a MassDEP Bill of Lading (BOL) in accordance with the provisions of 310 CMR 40.0030. Potentially, 800 cubic yards of excess soils may be generated and transported off-site for disposal as part of these RAM activities, however the exact volume will be dependent on conditions.encountered during the excavation.As such, this RAM Plan allows for the excavation and off-site disposal of up to 1,000 cubic yards of petroleum-affected soils. 2.2.7 RAM Implementation Schedule Mobilization of materials and equipment to the site is anticipated to occur at the beginning of August 2016. It is anticipated that field activities and site demobilization will be complete by the end of January 2017. A RAM Status Report will be submitted within 120 days from the submittal of the RAM Plan and then.:every six months thereafter until a RAM Completion can be submitted. A RAM Completion Report will be submitted within 60 days of completing the above mentioned RAM activities. II II i i 20162042/FRM16R44195 Page 5 of 9 July 27, 2016 KLE/NFELDER Bright People.Right Soludo m 3.0 PERMITTING Prior to beginning work, CFI's general contractor will obtain a DigSafe Ticket in addition to demolition and construction permits as required by the town. This RAM Plan is being submitted to MassDEP after the Tier Classification (Tier 1) for RTN 4- 14257, therefore no fee is required, as established in 310 CMR 4.0444(2)(a). In accordance with 40.1403(3)(d),:the Town Manager and Director of the Board of Health of the Town of Barnstable will be notified within 20 days of the implementation of RAM activities.This notification is provided by way of the attached cover letter included with this RAM Plan. j 20162042/FRM 1 6R44195 Page 6 of 9 July 27, 2016 KLE/NFELDER 'RrfghrV ple.Right SW rioru. 4.0 FINANCIAL ASSURANCE It is anticipated that u to 1 0 cubic r f it p p ,00 c yards o so may be excavated as part of this RAM. It is unknown how much of this material will require off-site disposal at this time. However, under the conservative presumption that more than 1,000 cubic yards may require off-site disposal, in accord ance:with 310 CMR 40.0442(5), CFI`as acting responsible party for the RAM has sufficient financial resources to manage remediation waste in accordance with this RAM Plan. I 20162042/FRM 1 6R44195 Page 7 of 9 July 27, 2016 KLE/NFELDER Bright Reuple.Right Snlutk k 5.0 REFERENCES AECOM Environment, 2003. "Phase III Addendum". Submitted January 2003. AECOM Environment, 2003. "Phase IV Remedy Implementation Plan". Submitted May 2003. AECOM Environment, 2004. "Revised Phase.IV-As-Built& Phase IV Final Inspection Report and Remedy Operation Status Report". Submitted February 2004. AECOM Environment, 2010. "Class C-1 Response Action Outcome". Submitted July 2010. Kleinfelder, 2016."Temporary Solution Status Report." Submitted July 8. Massachusetts Office of Geographic Information. °MassDEP Priority Resource Map." <http://maps.massgis.state.ma.us/images/dep/mcp/mcp.htm>. 20162042/FRM16R44195 Page 8 of 9 July 27, 2016 KLE/NFELOER Bright FeOple.Right Solutions. 6.0 LIMITATIONS This report was prepared in accordance with the standards of environmental practice generally accepted in the State of Massachusetts at the time of this investigation. This investigation was conducted solely for the purpose of evaluating subsurface environmental conditions at the subject site at the time of this investigation. Evaluation of the geologic and environmental conditions at the site for the purpose of the investigation was made from a limited number of data collection points and based on laboratory analytical results. Subsurface conditions.may vary away from the data points available for this investigation or at times_subsequent to the time of this investigation. 20162042/FRM16R44195 Page 9 of 9 July 27, 2016 FIGURES • fix, , R co jy a• f. i • y t • • a } r jYli" •y ♦ 7 - SITE LOCATION 1^ ♦ R .71 s a � � it b _ t _:.. ., `_ + .�� -ate- t } , �.�:• ♦ � .n"9k`.+- s. �.. "` ��� �' , i� • s m d - 2000 1;000'. 0 2,000 e e :APPROXIMATE'SCALE(FEET) , •'. � w MM ` < 1, • • o *'° "�` °©yrg'©2Qt3"I�at al Georaphrc Socetyi cubed; SOURCE PROJECT NO. V0990 FIGURE _.- MnssACHusE,rrsauaoRaNcLEtOCnTov DRAWN' DEC2011 SITE.LOCUS THE U2FORMAT0 FROM A VARIENOFSOURP CREPRESUBJECT?N - BEENCOMPS.ED FROMAVARIETT OF SDURCESANO'IS SUBJECT TO CHANGE MIIHOUT NOTICE,KLEwFEIDER MAKES NO REPRESENIATIONS //I�� DRAWN BYi CiTH ORWARRANTIES,EKPRESS ORIMPJEO,ASTOACCU"CG,COMRI,E'fENESS, KLH' AEL AEI 1 —I DOCUNESS.ORR INrADTHEUBEE SALANDQRMAT,DR.TNLS Bright People:RightSo/utions. CHECKED BY:_ CUMBERLAND FARMS#VO9901#2142 1 TIUEO DOCUMENT RbSOII NOT04EU USE SUCM INFORM ENN.TIVSI NOR i IS ITOLSIONEDOIZI TEN0E0 ASA i.ONSIRUCTtON4ESM.ND00051W. THE USECR MISUSE Of YHEINFORNAT{ON CONTAINED ONTH{SORAPIEIC - - "' REPRESENTATION SATTlIE SOLE PISK OF THEPA117v USSFSQR M{SUSIKO' FILENAME .. - • THE INFORMATON, :. .. y+ww.kleinfekleccom ::... . 39N WEST MAIN STREET V0990LOCU S:MXp HYANNIS,:MASSAC HIISETTS KLE/NFEL Daw Bright People.Right Solutions. 3> January 5, 2017 V }J Mr.Thomas McKean, Director Town of Barnstable Board of Health 200 Main Street w Hyannis, Massachusetts 02601 Re: Notification of Submittal of an Immediate Response Action Plan and Completion Report Cumberland Farms, Inc. Property#MA0990 395 West Main Street Hyannis, Massachusetts RTN 4-26421 Dear Mr. McKean: On behalf of Cumberland Farms, Inc., (CFI) and pursuant to the requirements of 310 CMR 40.1403, Kleinfelder is hereby providing you notification that an Immediate Response Action (IRA) Plan and Completion Report was filed with the Massachusetts Department of Environmental Protection (MassDEP) for the above referenced property on January 5, 2017. A copy of the IRA Plan and Completion Report may be obtained, or reviewed by appointment, at the MassDEP Southeast Regional Office located at 20 Riverside Drive, Lakeville, Massachusetts (Phone: 508-946-2700). It may also be downloaded online at: http://Public.dep.state.ma.us/SearchableSites2/Search.aspx. Based on field headspace screening results in excess of 100 parts per million by volume(ppmv)during the excavation of two previously unknown underground storage tanks on November 10th, 2016, a 72- hour reporting condition consistent with 310 CMR 40.0313(2)was interpreted to be applicable to the subject property. Verbal notification was provided by Kleinfelder, on behalf of CFI, to Mr. Jaime Goncalves of the MassDEP on November 10th, 2016 at 3:45 p.m. In response to this notification, the MassDEP assigned RTN 4-26421 to this release condition. Based on site assessment activities conducted in November and December 2016, and information regarding the site and surrounding receptors, a condition of Imminent Hazard or a condition of Substantial Release Migration does not currently exist at this site relative to RTN 4-26421 and the original condition resulting in the implementation of IRA activities has been effectively assessed in accordance with the applicable requirements of 310 CMR 40.0427. A figure depicting the site associated with RTN 4-26320 is attached for your reference. Should you have any questions please do not hesitate to contact the undersigned at(508) 270-6567. Sincerely, KLEINFELDER Emily M. Straley Project Manager Enclosure: Site Plan cc: Matthew Young, Cumberland Farms, Inc. (file) 20152826.007A/FRM17L52437 MA0990/Town Public Notice 1-17 1 Speen Street, Suite 200, Framingham, MA 01701 p 1508.370.8256 f 508.628.1401 KLE/NFELOER Bright People.Right Solutions. Certified Mail#70020510000293565865 November 14,2012 Town of Barnstable 367 Main Street Hyannis, MA1 02601 Re; Monitoring Data Collected at Right-of-Way/Suomi Road Hyannis„MA 02601 4=14257 To.Whom.it May Concern_` Cumberland Farms, Inc. (CFIJ is.completing environmental investigation.activities in accordance with 310 CMR 40.0000 at''Facility # V0990 / Station:# 2142,+395 West Main Street, Hyannis, MA: Kleinfelder completed a. groundwater monitoring event on October 3, 2012 at the above referenced location. On October 3,, 2012, Kleinfelder personnel gauged depth to water and collected groundwater samples from monitoring wells MW-5, MW-51), and MW-9.(see attached site.plan for locations). The results of this monitoring event are enclosed. Additional information pertaining to this sampling event is included on BWSC Form 123, This information is being provided to you based.on records that indicate you as'the owner of the Public right-of-way located on Suomi Road. Information regarding public ` involvement opportunities are available under 310 CMR 40.1403(9). A copy of these laboratory reports will also be provided to the Massachusetts Department of Environmental Protection (MassDEP) with the next required regulatory report submittal. C CFI is scheduled:to complete monitoring activities on a semi-annual basis. The next monitoring r event is scheduled for April 2011 The results of this monitoring event will be forwarded to you `V within 30 days of receipt of the.laboratory results. Thank you for your continued cooperation: Should. you have any questions regarding this matter, please do not hesitate to contact meat(800) 522-8740 x 558: Sincerely, KLEINFELDER ;_ Moira Johnson Project Manager Cc: Matt Young:—CFI (electronic) 129959/FRM12L0686 V0990/Sampling Results 11=12 1 Speen Street,Suite Framingham, R&�dtmi p(5a&3m.a256 f l 5Q8.6Z8.14a1 NOTICE OF ENVIRONMENTAL SAMPLING As required by 310 CMR 40.1403(10)-of the Massachusetts Contingency Plan BWSC 123 This Notice is Related to Release Tracking Number 14257 A. The address of the disposal site related to this Notice and,Release Tracking Number(provided above): 1. Street Address: 395 West.Main Street City/Town: Hyannis-, Zip.Code 02601 B. This notice is being provided to the following party: 1. Name: Town of Barnstable 2: Street Address:. 36.7 West Main-Street City/Town: Hyannis Zip.Code: 02601 C: This notice is being given to inform its recipient.(the party listed in Section B): P711.That environmental sampling will be/has been conducted at property owned by the recipient of this notice. ✓/ 2.Of the results of environmental sampling conducted at property owned by the recipient of 1his notice.. ❑✓ 3. Check to indicate:if the.analytical results are attached: (If item 2. above is checked,the analytical results from. the environmental sampling must be attached to this notice: D: Location.of the property where the environmental sampling will be/has been conducted: 1. Street Address: Right-of-Way/Suomi Road . City/Town: Hyannis_ Zip Code:. 02601 2. MCP phase of work during which the sampling will be/has been conducted: ❑immediate Response Action Phase III Feasibility Evaluation D Release Abatement Measure. Phase IV Remedy Implementation Plan El-Utility-related Abatement Measure E Phase V/Remedy Operation Status 0 Phase I Initial Site Investigation. ❑✓ Post-Class C Operation, Maintenance and Monitoring. Phase II Comprehensive Site Assessment ❑ Other (specify). 3. Description of property where sampling will be/has been:conducted: residential commerical 0 industrial ❑school/playground 0✓ Other Right-of-Way (specify) 4.`Description of the sampling locations and types(e,g:, soil,groundwater}m the extent known.at the#ime:of this.notice: Groundwater at MW-5,MW-5D, and MW-9 EContact information related to the party providing this notice: L 71 Contact Name: Kleinfelder-Moira S.:Johnson Street Address: 1 Speen Street, Suite 200 city/Town: Framingham : . Zip Code:, 01701 Telephone: (508)270-6558 Email: msjohnson@kleinfelder.00m NOTICE OF ENVIRONMENTAL SAMPLING As required by 31.0.CMR 40.1403(10) of the Massachusetts on Plan MASSACHUSETTS REGULATIONS THAT REQUIRE THIS NOTICE This notice, is being provided pursuant to the.Massachusetts Contingency Plan and the notification requirement at 310 CMR 40.1403(10). The Massachusetts Contingency Plan is a state regulation that specifies requirements for parties who.are taking actions to address releases of chemicals.(oil or - hazardous material.)to the environment: THE PERSON(S) PROVIDING THIS NOTICE This notice has been sent to you by the:party who is addressing a release of oil or hazardous,material to the .environment. at the location listed in Section A on the reverse side of this :form.. (The regulations refer to the area where the oil or hazardous,material is present a8 the "disposal.Site".) PURPOSE OF THIS NOTICE When environmental samples are taken as part of an investigation under the Massachusetts Contingency Plan at a property on behalf of Someone other than the owner of the property, the regulations require that the property owner (listed in Section B on the reverse side of this form)be given notice of the environmental sampling. The regulations also require that the property owner subsequently receive the analytical results following the analysis.of the environmental.samples. Section.0 on the reverse side of thi8 form. indicates the.circumstance Under which'you are receiving this notice at this time If you are receiving this notice to. inform you.of the analytical results'following the analysis of the environmental samples, you should also have received; as an attachment, a copy Of analytical results. These results should. indicate the number and type(s) of samples (e.g:, soil, groundwater). analyzed,. any chemicals identified, and the measured concentrations of those chemicals. Section D on the reverse side.of this form identifies the property.where the environmental.sampling will be/has been conducted, provides a-description of the sampling locations within the property, and indicates the. phase of work under, the Massachusetts Contingency ,Plan.regulatory process during Which.the samples will be/were collected. FOR MORE INFORMATION .Information about the general process for addressing releases of oil:or hazardous material,under the Massachusetts Contingency Plan and related public involvement opportunities may.be found at http://www.mass.gbv/dep/cleanup/oview.-htm. For more information regarding this. notice;.you may contact the party listed in Section E on the reverse side of this form. Information about the disposal site identified in Section.A is also:available in.files at the Massachusetts Department of.Environmental Protection. See http://mass.gov/deb/about/r6gion/schedule.htrh if . you _would Jike to 'make an appointment.to see these.files.. :Please.reference the Release Tracking.Number listed in.the upper right hand corner on the reverse side.of this form when making file review appointments. so G� JAMES MORETTI ' LEGEND RESIDENTIAL 50 SUOMI RD. 'pO 90 M B tD MONITORING WELL 1 DESTROYED MONITORING WELD, 7 SOIL GAS POINT RESIDENTIAL SOIL VAPOR MONITORING POINT yy !! 34 SUOMI RD,- C i SHADY LANE .. — PROPERTY BOUNDARY-- ® CATCHBASIN UTILITY POLE - O DAVIDSOMERO - A SOIL BORING B-1 ADVANCED ON 10/.31/00 BY ECS. WAYNE ZERRIS VACANT 30 SUOMI RD. RESIDENTIAL - SOIL BORINGS BMW-4 AND BMW-7 . - 67SHADY.LANE- - - - ADVANCED ON 04/1 BI02. —W WATERLINE . - - —SS SANITARY SEWER.LINE CARL E.MUELER - RESIDENTIAL WAYNE ZERRIS. —;OAS— NATURAL.GAS - 22SUOMI RD.. - VACANT 'RESIDENCE RESIDENCE 85 SHADY LANE�` LISTS UNDERGROUND STORAGE TANKS +` ..POST EXCAVATION SOIL SAMPLING LOCATIONS THOEDORE —.——.—.—— —--, .ON 10/15/98 AND 1021198 W-17 'C MBERI D FARMS VACANT VACANT I. WEST MAIN RAO AREA . L. GIO . AUTO: - .. . OFFICE. I. .. ... _ 'NW SIDEWALL :I (FOOT D) - GENERAL NOTES. , BASE EAST - .SITE PLAN PREPARED.FROM A TOWN OF HYANNIS ASSESSORS MAP, - (FOOT D) I ALFRED AND LEAH ZERRIS SITE PLAN BY ECS,AND SITE RECONNASSAINCE BY ENSR.ALL MW USTs I 405 WEST MA N ' LOCATIONS,DIMENSIONS,AND PROPERTY LINES DEPICTED ON THIS B CANOPY I AUTO' `PLAN ARE APPROXIMATE.THIS PLAN SHOULD NOT BE USED FOR . . -6 CONSTRUCTION OR LAND CONVEYANCE PURPOSES.HORIZONTAL, W-2. - - AND VERTICAL LOCATIONS OF WELLS,AND SELECTED SITE FEATURES EAST SIDEWALL DETERMINED THROUGH MEASUREMENTS MADE BY - .:'Ip BASE EAST - REPRESENTATIVES OF ENSR. . SW BASE(FOOT 5 yy BASE WEST O NOTES: GS-1 (FOOT A.c d 4 M -1 -1.ALL LOCATIONS AND DIMENSIONS OF SITE AND ,SESASE(FOOT.B) g ;�WSAS _ _ NO.OF TANKS TANK SIZE TANK CONSTRUCTION TANK CONTENTS INSTALLATION DATE REMOVAL DATE OEAR VICINITY FEATURESARE APPROXIMATE FOOT C)�ws !aAa �,— otis_ 1- 5,000 WA GASOLINE WA NOVEMBER 1982 2.ALL WELLSWERE SURVEYED-BY GTI. BE SIDEWALL L BE SIDEWALC - 1 2,000 .WA GASOLINE WA NOVEMBER 1982 3.GROUNDWATER CONTOURSARE INTERPOLATED� - ss '6 ssss -O�-C}—ss. BETWEEN DATA POINTS AND INFERREDIN. W. 1 .2,OD0 WA DIESEL WA NOVEMBER 1982 OTHER AREAS. - - - WEST MAIN ROUte 28 STREET - - - 4 8.00D FIBERGLASS. GASOIWE bECEMBER1982. IN USE - 4.FIGURE DERRIVED FROM(SITE INFORMATION _ _ ._ _ NOTES. .. - .. . MAP',BY GROUNDWATER AND INFERRED IN. RICHARD GRIFFIN THIS INFORMATION WAS.COMPILED BASED ONAVAILABLE HANDEX OF ME INC.RECORDS AND OTHER AREAS TECHNOLOGY,INC.NORWOOD, COUNTRY-GORDEN NURSERY PARK PLACE CONDOS FISH AND LOBST LOCAL RECORDS. ' 380 WEST MAIN STREET - 398 WEST MAIN ST." ' OHN F.CARDARELLI TRUS 'WA•INFORMATION WAS NOT AVAILABLE., MA OCTOBER 5,1892 .. - - 406 WEST MAIN STREET G PROJECT NO '2142 � .PLATE c �� DRAWN: DEC2011 SITE PLAN 60 30 0 60 DRAWN BY:ERIL KLE/NFELOER FERRE'RA 2 APPROXIMATE SCALE(feet) Sogrofaris CHECKED BY: CUMBERLAND FARMS#2142 �� os,e,v r aswa.ro•a.+cw � aZ FILENAME: 395 WEST MAIN STREET HYANNIS,MASSACHUSETTS 2142DEC11.dwB Report Date: ®' Final Report 18-Oct-12 14:1.6 0� � (3 Re-Issued Report. i13Revised Report t �„ l SPECTRUM ANALYTICAL,INC. Featuring HANIBAL TECHNOLOGY Laboratory Report Kleinfelder,Inc. 1 Speen Street,Suite 200 Project: V0990/21.42'-395 West Main.St Hyannis;MA Framingham,MA 01701 . Project#:.V0990/2142 Attn:Moira Johnson Laboratory ID Client Sample ID Matrix Date Sampled Date Received 77 S1357824-01 GS=1 Ground Water. 03-Oct-12 10:15 05-Oct-12.18:45 SB578247-02 GS-2 Ground Water 03-Oct-12 10:45 05-0ct42 18`:45 SB57824-03 GS-3 Ground Water 03-Oct-12 11:22 05-Oct42.18:45 SB57824-04 MW-5 Ground Water 03.Oct-12 0835 05-Oct-12 18:45 SB57824-05 MW-51) Ground Water 03-Oct-12 09.00 0570ct-12 18:45 S1357824-06 MW-8 Ground Water. 03-0ct-12 08:15 05-Oct-12 18:45 SB57824-07 MW-9 Ground Water 03-Oct-12 09:45 05-0ct-12 18:45 SB57824-08 MU11-11 Ground Water. . 03-Oct-.12 11:50 05-0ct42 18:45 SB57824-09 DUP Ground Water 03-0ct-12 12:00 05-Oct-1218:45 S1357824-10 QCTB Ground Water 03-OcW2 00:00 05-0ct-12 18:45 I attest that the information contained within the report has been reviewed for accuracy and checked against the quality control requirements for each method. These results relate only to the sample(s)as received. All applicable NELAC requirements have been met. Massachusetts#NI7MA138MIA1110 Authorized by: Connecticut#PH-0777 Florida.#E87600/E87936 Maine#MA138 New Hampshire#2538 2 G New Jersey MA01 IIMA012 New York.#11393/11940 Nicole.Leja Pennsylvania#68-04426/68-.02924 Laboratory Director. Rhode Island#98 e� USDA#S-51435 Spectrum Analytical holds certification in the State of Massachusetts for the analytes as indicated with an Kin the"Cert."column within this report. Please note that the State of Massachusetts does.not offer certification for all analytes. Pleaserefer to our website for specific certification holdings,in each state. Please note that this.report contains 20 pages.of analytical data us Chairi of Custody document(s). When the Laboratory Report is` indicated as revised,this report supersedes any previously dated reports for the laboratory ID(s)referenced above. Where this.report' identifies subcontracted analyses,copies of the subcontractor's test report are'availabie upon request. This report may not be reproduced,except in full,without written approval from Spectrum Analytical,Inca Spectrum Analytical,Inc.is a NELAC accredited laboratory organization and meets NELAC testing standards. Use of the NELAC logo however does not insure that.Spectrum:is currently accredited for thespecifrc method or anglyte indioated:.Please refer to our "Quality".web gage at www.specttirm-analytical:com jor.a full listing of our.current certifications and fields of acereditation..States in which Spectrum Analytical,Inc. holds NELAC certification are:New York New Hampshire,New Jersey and Florida.All analytical work for Volatile Organic and Air analysis are transferred to and.conducted at our 830 Silver Street location(NY 11840,FL-E87936 and NJ-MA012). Please contact the Laboratory or Technical Director at 800-789--9115 with any questions regarding the data contained in this laboratory.report K wdgaarters:11 Ahq&=Drive.&830 Silver Street•Agawam;MA 01001•1-800-789-9115-413-789-9018•Fax 413-789-4076 ocal.com Page 1 of 26 SamD le Identification Client Proiect# Matrix Collection Date/Time Received MW-S V0990/2142 Ground.Water 03-Oct-1208:35 05-Oct-12 SB57824-04 CASNo Analyte(s) Result Flag Units *'RDL MDL Dilution Method Ref. Prepared. Analyzed Analyst Batch CerG Volatile,Organic Compounds VPH Aliphafic(Aromatic Carbon Ranges GSI Prepared by method VPH-EPA 50306 C5-CS Aliphatic 770 q Pgll 375: 27.8 25 MADEP VPH_ 12-W-12 12-W-12 mp 1224930 Hydrocarbons, 51M Rev.1.1 C9-Ct2.Aliphatic 1,670 D Pgll. 125 21.1,. 25 Hydrocarbons C9-C10 Aromatic 1,880 D Ugly 125' 5.60 25 Hydrocarbons Unadjusted C5-C8 883 . D. PgA 375,, 35.5. 25 ° Aliphatic Hydrocarbons Unadjusted C9-C12 3,55.0 D PgA V5 23.4 25 ' Aliphatic Hydrocarbons VPH Tardet Analvtes 0S1 Prepared by method VPH-EPA 5030E - 71d3-2 Benzene <25.0 D. N911 25.0. 6.3. 25 100-41=4 Ethylbenzene <25.0.. D pgn 25.0 7.0 25 1634A" Methyl-tert-butyl.ether <25;0 D PgA 26.0_ T& 25 - - 91-20.3 Naphthalene -25.0 D PgA 25.0 5.8 25 " 108883 Toluene <25:0 R Pg4 25.0 6.4 25 • ' 179601-231 m.p-Xylene 83.2- D - - - PgA_. - 50.0 13.8 25 ar-6 o-Xylene <25.0 D P9A 25.0 .5.6 25 ' Surrogate recoveries: 615-59-8 2,5-Dibromotoluene(FID) 96 70-130% 615-59-8 2,5-DibromotO/uene(PID) 82 70.110Yo nis laboratory report is not valid without an authortwd signature on the coverpage. 18-0gt-12 14:16 •Reportable Detection Limit Page 8 of 26 Sarnple Identification Client Project# Matrix Collection Date/Time Received MW 5D V0990/2141 Ground Water 03-Oct-12 09:00 05-Oct-12 SB57824-05 CASN6. Analyte(s) Result Flag Units *RDL MDL. Dilution Method Ref. Prepared Analyzed Analyst Batch Cert Volatile,Organic Compounds VPH AliphaticlAromatic Carbon Ranges Prepared by method VPH-EPA 5030E CS-CS Aliphatic <75,0 D p9n 75.0 5.55 5 MADEP VPH 12-W-12 12-W-12 mp 1224930 Hydrocarbons 512004 Rev.1.1 C9-C12Aliphatic. <25.0 Q pgll 25.0 4.22. 5 Hydrocarbons C9-C10 Aromatic - <25..0 D 094 25.0' 1.12 5 ' Hydrocarbons Unadjusted C5-C8 <75.0 D pgA 75.0 7.10 5. ' Aliphatic Hydrocarbons Unadjusted C9-C12 30.7 D pgll 25.0 4:68 5 ' Aliphatic Hydrocarbons VPH Taroet Analvtes, . Prepared bG method VPH'=EPA 5030E 71d3.2 Benzene <5:0 D pgll. 5.0 1.3 5 100.41-4 11 Ethylbeniene <s.0 D P9I1 5.0 1.4 5 , 1e34-04-4 Methyl tert-butyl ether <5.0 U. Ngll 5.0 1.6 .5 91.20.3 Naphthalene <5.0 D pgA 5.0 108.88.3 Toluene- <5.0 4 p9n 5.0 1.3 5 179e01.23.1 m,p-Xylene. <10.0 P pqq 10.0 2.8' 5 ' 95.47-6 o-Xylene <5.0 D 5.0 1.1 5 Surrogate recovenes 61559.8 2,S-Dibromotoluene(FID) 83 70730% 615.59-8 Z5-Dibromotoluene(PID) 72 70.130%a This laboratory report is not valid without an authorized signature on the cover page: 18-Oct-1214:16 a Reportable Detection Limit Page 9 of 2b • SarnRle Identification Client Proiect# Matrix Collection Date/Time Received MW-9 V6990/2142 Ground Water 03-Oct-12 09:45' 05-Oct-12 SB57824-07 CASNo. Ana4le(s) Result Flag Units -RDL MDL Dilution Method Ref. Prepared. Analyzed Analyst Batch CerL Volatile Organic Compounds VPH Aliphatic/Aromatic Carbon Ranges Prepared by method VPH-EPA 50306 C57C8 Aliphatic <75.0 q UgII. .75.0 5.55 5 MADEP VPH ... 12-W-12 12-W-12 mp 1224930 Hydrocarbons , 5/2004 Rev.1.1- C9-C12 Aliphatic <25.0 D pgh. 25.0 4.22 5 " Hydrocarbons C9-CIO Aromatic <25.0 D pgA 8.0 1.12 5 Hydrocarbons Unadjusted CS-C8 <75.0 D. pgn 75.0 7.10 5 Aliphatic Hydrocarbons Unadjusted.C9-C12 <.25.0 D pgn. 25.0 4.66 5. Aliphatic Hydrocarbons VPH Tardet AnAytes Prepared by method VPH EPA 50306 71d32 Benzene <50 D Pgn 5.0 1.3 5 10041-4 Ethylbenzene <5.0 D pgA 5.0 1.4 5 ° 1834-04-4 Methyl tert-butyl ether - <5.0 0 U9II 5.0 is 5 ' 81-2D Naphthalene <5.0 D Pg 5.0 1.2 5 " t08 t18,4 Toluene <5.0 D Pgll. 5.0 1.3 5 ' 179601-23-1 mpp-Xylene. <10.0 P Pg4 10.0 2.8 5.' ' 95-47-8 o-Xylene <5.0 D Vol 5.0 1.1 5 Surrogate recoveries: 615-59a 1 ZS-Dibromotoluene(FID) 88 70=130%. 615-5978 Z-5 Dibromofoluene(PID) 76 70•130% ' This.laboratory report is not valid without an authorized signature on the eoverpage. 18-0et-1214;16 s Reportable Detection Limit Page 11 of 20 . { rt JJ Special HanLLimg: Standard TAT'-7'to 10 business da s I l Rush TAT-Date Needed: . x�. C .Ilv, Ol.'-CUSTODY.RECORD: e.All TATs subject to laboratory approval. Min.i4-hour notification needed foi rushes. Y„ SPECTRUM ANALYTICAL INC i. Featuring A p `fit,`gyp iy' i" ;Page `_.of Samples disposed of after 60 daj s unless a '� otherwise.instructed; `-H"AL-7B M0LOCx:r .. tt .'�r.�.,t .. " ,.tt,,- ;, RePleinfeliler Irivotce To: �(�CJ 9� /�J '1 15peen Street 4 Cumberland Farms "Pro ect Na , I Mr.Matt Young-.. ! , !v� . Framingham,Me :z t ar Site Name: �395 2S i7Q ih s� ssin s Blv Y ;. 1' � 00 Crti g d. ,w ? P 508-370 8256 F 508-628 1401 r+ • 4 _ Fremmgham,MA Location r?i_S t State t ' Te1e mslohnson@kiemfelder.com i .w � P.O No..' =RON <: w' t Sampler(s): Project Mgr: ' ,a ; tt :e _ a. 1=Na2S2Oj ' 2=HCl 3=HZSO4' "4=HNOj 'm'5=NaOH` 6=Ascorbic Acid 7�H30H List reservative code below:' 'QA/QC�a ortin Notes: P g ., 8=NaHSO, .9=Deionized Water„ 10=H3P& l l . .«' 12= ` A.addtttona charges may appty E DW=Arinking Water' GW=Groundwater WW Wastewater :'; Containers s I . lAnal ses: DEPMCPCAMReport:ves*o❑ G rv5 O it SW=Surface Water SO=So11+ ,SL 'Sludge y. ,=Air { CTDPxRCPRepoitWs❑No❑ ' XI= r 3 X2 �. X3 r� ' , y e� t ; 3 .:` v, pordag No DQA" QC tie Lev (Standard •.❑ ❑ 1 ' c .� �, U` ci r it ; p ❑NYASPA• ❑NYASPB"' t I ¢ .G=GrabA.C=Compos'Ite i d �' 3 c ,. S ❑N Red ned"` ❑�NJ F. yF,ayY U 'A x z ❑JTtFR " '� R]y" a _ , •i i y nc ,� c c c c y' 4 ❑:Other ' lab id: Sam"le Id : - Date,�, .. Time. , F" ;. State- ecific re rtin standards: •✓ '4•'.J J u µ4 3� .. Y '}. 7:1 � r C. k, 5 r•t tTM c • t + .6 c .Y� tit r, 3 'i 6 r i �G V - (B l 1 �` r, E 1' 1 is i r , `5' •r` '4 (�r 13 t< i Vl}✓ [� U y , t Z, e Relin.unshed b' * , " 'xa Reeerveil`b'" i Date: Timer':3 TAP°�; 0 E , w • <}, rm t � l �DD.Fo `r -mail to. r•A -T6A w) at- A s + t ` t S k� • .mot. __.. 77 ,. pp �. - t x Condition upon receipt � " u° f 1 t T x S. in ❑'Ambient ❑toed `t❑DI VOAFtirwn u❑Siiil9arFrozeo+ Ahiplgren Drive•Agawam MA 01001•413-789-0018•FAX 413-789-4076 www.spectrum-analytical.com Revised Feb 20i2• ..,r,,...�. as � _:�'�'*t , ,t:...• t ..� ,u KLEINFELOER _ . Bright People.Right Solutions. Certified Mail #70090080000175825930 December 28, 2011 Town of Barnstable 367 Main Street Hyannis, MA 02601 Re: Monitoring Data Collected at Right-of-Way/.Suomi Road Hyannis, MA 02601 4-14257 To Whom it May Concern: Cumberland Farms, Inc. (CFI) is completing environmental investigation activities in accordance with 310 CMR 40.0000 at Facility# V0990 / Station # 2142, 395 West Main Street, Hyannis, MA. Kleinfelder completed a groundwater monitoring event on October 21, 2011 at the above referenced location. As of June 28, 2011, Kleinfelder was retained by CFI to provide consulting services on their behalf at this location. Additional fieldwork will be completed by CFI and Kleinfelder. On October 21, 2011, Kleinfelder personnel gauged depth to water and collected groundwater samples from monitoring wells MW-5, MW-5D, and MW-9 (see attached site plan for locations). The results of this monitoring event are enclosed. Additional information pertaining to this sampling event is included on BWSC Form 123. This information is being provided to you based on records that indicate you as the owner of the Public right-of-way located on Suomi Road. Information regarding public involvement opportunities are available under 310 CMR 40.1403(9). A copy of these laboratory reports will also be provided to the Massachusetts Department of Environmental Protection (MassDEP)with the next required regulatory report submittal. CFI is scheduled to complete monitoring activities on a semi-annual basis. The next monitoring event is scheduled for April 2012. The results of this monitoring event will be forwarded to you within 30 days of receipt of the laboratory results. 123334/LITMA11 L213_V0990/Sampling Results 12-11 Page 1 of 2 1 Speen Street, Suite 200, Framingham, MA 01701 p 508.370.8256 f 1508.628.1401 u t KLE/NFELOER SITYM hnple.W9h'.Wwh" Thank you for your continued cooperation. Should you have any questions regarding this matter, please do not hesitate to contact me at(800) 522-8740 x 558. Sincerely, KLEINFEL®ER Moira Johnson Project Manager Enclosures Cc: Kleinfelder(file) Matt Young — CFI (electronic) 123334/LITMA11 L213 V0990/Sam lin Results 12-11 Page 2 of 2 _ P 9 g 1 Speen Street, Suite 200, Framingham, MA 01701 p 508.370.8256 f 508.628.1401 u NOTICE OF ENVIRONMENTAL SAMPLING As required by 310 CMR 40.1403(10) of the Massachusetts Contingency Plan BWSC 123 This Notice is Related to Release Tracking Number 4� 14257 A. The address of the disposal site related to this Notice and Release Tracking Number(provided above): 1. Street Address: 395 West Main Street City/Town: Hyannis Zip Code: 02601 B. This notice is being provided to the following party: 1. Name: Town of Barnstable 2. Street Address: 367 West Main Street City/Town: Hyannis Zip Code: 02601 C. This notice is being given to inform its recipient(the party listed in Section B): ❑✓ 1. That environmental sampling will be/has been conducted at property owned by the recipient of this notice. ❑✓ 2. Of the results of environmental sampling conducted at property owned by the recipient of this notice. ✓❑3. Check to indicate if the analytical results are attached. (If item 2. above is checked, the analytical results from the environmental sampling must be attached to this notice. D. Location of the property where the environmental sampling will be/has been conducted: 1. Street Address: Right-of-Way/Suomi Road City/Town: Hyannis Zip Code: 02601 2. MCP phase of work during which the sampling will be/has been conducted: ❑Immediate Response Action ❑ Phase III Feasibility Evaluation ❑Release Abatement Measure ❑ Phase IV Remedy Implementation Plan ❑Utility-related Abatement Measure ❑ Phase V/Remedy Operation Status ❑Phase I Initial Site Investigation ❑✓ Post-Class C Operation, Maintenance and Monitoring ❑Phase II Comprehensive Site Assessment ❑ Other (specify) 3. Description of property where sampling will be/has been conducted: El residential ❑commerical ❑industrial ❑school/playground ❑✓ Other Right-of-Way (specify) 4. Description of the sampling locations and types(e.g., soil, groundwater)to the extent known at the time of this notice. Groundwater at MW-5, MW-51D, and MW-9 E.Contact information related to the party providing this notice: Contact Name: Kleinfelder- Moira S. Johnson Street Address: 1 Speen Street, Suite 200 City/Town: Framingham Zip Code: 01701 Telephone: (508)270-6558 Email: msjohnson@kleinfelder.com NOTICE OF ENVIRONMENTAL SAMPLING As required by 310 CMR 40.1403(10) of the Massachusetts Contingency Plan MASSACHUSETTS REGULATIONS THAT REQUIRE THIS NOTICE This notice is. being provided pursuant to the Massachusetts Contingency Plan and the notification requirement at 310 CMR 40.1403(10). The Massachusetts Contingency Plan is a state regulation that specifies requirements for parties who are taking actions to address releases of chemicals (oil or hazardous material) to the environment. THE PERSON(S) PROVIDING THIS NOTICE This notice has been sent to you by the party who is addressing a release of oil or hazardous material to the environment at the location listed in Section A on the reverse side of this form. (The regulations refer to the area where the oil or hazardous material is present as the "disposal site".) PURPOSE OF THIS NOTICE When environmental samples are taken as part of an investigation under the Massachusetts Contingency Plan at a property on behalf of someone other than the owner of the property, the regulations require that the property owner (listed in Section B on the reverse side of this form) be given notice of the environmental sampling. The regulations also require that the property owner subsequently receive the analytical results following the analysis of the environmental samples. Section C on the reverse side of this form indicates the circumstance under which you are receiving this notice at this time. If you are receiving this notice to inform you of the analytical results following the analysis of the environmental samples, you should also have received, as an attachment, a copy of analytical results. These results should indicate the number and type(s) of samples (e.g., soil, groundwater) analyzed, any chemicals identified, and the measured concentrations of those chemicals. Section D on the reverse side of this form identifies the property where the environmental sampling will be/has been conducted, provides a description of the sampling locations within the property, and indicates the phase of work under the Massachusetts Contingency Plan regulatory process during which the samples will be/were collected. FOR MORE INFORMATION Information about the general process for addressing releases of oil or hazardous material under the Massachusetts Contingency Plan and related public involvement opportunities may be found at http://www.mass.gov/dep/cleanup/oview.htm. For more information regarding this notice, you may contact the party listed in Section E on the reverse side of this form. Information about the disposal site identified in Section A is also available in files at the Massachusetts Department of Environmental Protection. See http://mass.gov/dep/`about/region/schedule.htm if you would like to make an appointment to see these files. Please reference the Release Tracking Number listed in the upper right hand corner on the reverse side of this form when making file review appointments. so Ly JAMES MORETTI LEGEND RESIDENTIAL .p v 50 SUOMI RD. 9 O M 1 MONITORING WELL E m yy DESTROYED MONITORING WELLI aii T SOIL GAS POINT N DAVID SOMERO RESIDENTIAL } SOIL VAPOR MONITORING POINT 34 SUOMI RD. a ---.- PROPERTY BOUNDARY SHADY LANE ® CATCHBASIN 0 G a UTILITY POLE O DAVID SOMERO ® SOIL BORING B-1 ADVANCED ON 10/31/00 BY ECS. a - VACANT WAYNE ZERRIS 30 SUOMI RD. RESIDENTIAL • SOIL BORINGS BMW-0 AND BMW-7 67 SHADY LANE ADVANCED ON 04/18102. —W— WATER LINE --65-- SANITARY SEWER LINE CARL E.MUELER RESIDENTIAL WAYNE ZERRIS —GAS— NATURAL GAS 22 SUOMI RD. - VACANT RESIDENCE .g RESIDENCE 65 SHADY LANE USTs UNDERGROUND STORAGE TANKS + POST EXCAVATION SOIL SAMPLING LOCATIONS THOEDORE H -I ON 10/15/98 AND 10/21/98 C MBER D -11 I FARMS VACANT VACANT I WEST MAIN ® RAO AREA EGIONA AUTO _ OFFICE NW SIDEWALL (FOOT D) GENERAL NOTES: BASE EAST i SITE PLAN PREPARED FROM A TOWN OF HYANNIS ASSESSORS MAP, (FOOT D) ALFRED AND LEAH ZERRIS SITE PLAN BY ECS,AND SITE RECONNASSAINCE BY ENSR.ALL MW. USTs I 405 WEST MA N LOCATIONS,DIMENSIONS,AND PROPERTY LINES DEPICTED ON THIS O CANOPY I AUTO PLAN ARE APPROXIMATE.THIS PLAN SHOULD NOT BE USED FOR W-B CONSTRUCTION OR LAND CONVEYANCE PURPOSES.HORIZONTAL, MW_2 AND VERTICAL LOCATIONS OF WELLS,AND SELECTED SITE FEATURES EAST SIDEWALL DETERMINED THROUGH MEASUREMENTS MADE BY REPRESENTATIVES OF ENSR. a BASE EAST a SW BASE(FOOT ) U - BASE WEST MN'-1 O NOTES: GS-1 (FOOT C-0) �p - M _-0 1.ALL LOCATIONS AND DIMENSIONS OF SITE AND 3 (MW SE BASE(FOOT B) g I - NO.OF TANKS TANK SIZE TANK CONSTRUCTION TANK CONTENTS INSTALLATION DATE REMOVAL DATE NEAR VICINITY FEATURES ARE APPROXIMATE CB -SW BASE —.—.—._. ONLY. FOOT C Gns • 1 5.000 N/A GASOLINE WA NOVEMBER 1982 —cas G>s cas— 2.ALL WELLS WERE SURVEYED BY GTI. SE SIDEWALL SE SIDEWALL 1 2.000 N/A GASOLINE NIA NOVEMBER 7982 3.GROUNDWATER CONTOURS ARE INTERPOLATED 9 ss(FOOT C) ��� 1 2,000 NIA DIESEL WA NOVEMBER 1982 U BETWEEN DATA POINTS AND INFERRED IN �"— F OTHER AREAS. WEST MAIN Route 28 STREET - 4 8,000 FIBERGLASS GASOLINE DECEMBER 1982- IN USE w 4.FIGURE DERRIVED FROM"SITE INFORMATION NOTES: MAP",BY GROUNDWATER AND INFERRED IN RICHARD GRIFFIN THIS INFORMATION WAS COMPILED BASED ON AVAILABLE HANDEX OF WE INC.RECORDS AND a COUNTRY GORDEN NURSERY PARK PLACE CONDOS FISH AND LOBSTE LOCAL RECORDS. Er OTHER AREAS TECHNOLOGY,INC.NORWOOD, 3B0 WEST MAIN STREET 398 WEST MAIN ST. OHN F.CARDARELLI TRUS WA=INFORMATION WAS NOT AVAILABLE. a MA.OCTOBER 5,1992 406 WEST MAIN STREET Y a PROJECT NO. 2142 PLATE DRAWN: DEC2011 SITE PLAN Z �� 9.,."� � . 60 30 0 60 DRAWN BY:ERILYERREIRA w a _ KLE/NFELOER CHECKED BY: APPROXIMATE SCALE(feet) �BrlghtPkople RlgMSdutlats C 5 WEST MAIN N 2 FILE NAME: O O= www.klelnfeltler—M HYANNIS,3 MASSACHUSETTS 2142DEC71.tlwg U a0 Report Date: t [;X Final Report 10-Nov-11 11:26 ❑ Re-Issued Report K ❑ Revised Report gg , SPECTRUM ANALYTICAL,INC. Featuring HANIBAL TECHNOLOGY Laboratory Report Kleinfelder,Inc. 1 Speen Street,Suite 200 Project: Hyannis-395 Main St-MA Framingham,MA 01701 Project#: V0990 Attn:Moira Johnson Laboratory ED Client Sample ID Matrix Date Sampled Date Received SB38215-01 MW-5 Ground Water 21-Oct-11 11:45 26-Oct-I1 17:05 SB38215-02 MW-51) Ground Water 21-Oct-11 13:00 26-Oct-11 17:05 SB38215-03 MW-8 Ground Water 21-Oct-11 10:30 26-Oct-11 17:05 SB38215-04 MW-9 Ground Water 21-Oct-I1 11:00 26-Oct-I1 17:05 SB38215-05 MW-11 Ground Water 21-Oct-I1 13:15 26-Oct-I1 17:05 SB38215-06 GS-1 Ground Water 21-Oct-I1 13:45 26-Oct-11 17:05 SB38215-07 GS-2 Ground Water 21-Oct-I1 12:45 26-Oct-I1 17:05 SB38215-08 GS-3 Ground Water 21-Oct-I1 12:15 26-Oct-I1 17:05 SB38215-09 DUP Ground Water 21-Oct-11 00:00 26-Oct-11 17:05 I attest that the information contained within the report has been reviewed for accuracy and checked against the quality control requirements for each method. These results relate only to the sample(s)as received. All applicable NELAC requirements have been met. Massachusetts#M-MA138/MA1110 Authorized by: Connecticut#PH-0777 Florida#E87600/E87936 J�u � Maine#MA138 � � New Hampshire#2538 New Jersey#MAO11/MA012 ; New York#11393/11840 � Nicole Leja Pennsylvania 4 68-04426/68-02924 q Laboratory Director Rhode Island#98 USDA#S-51435 Spectrum Analytical holds certification in the State of Massachusetts for the analytes as indicated with an X in the"Cert."column within this report. Please note that the State of Massachusetts does not offer certification for all analytes. Please note that this report contains 16 pages of analytical data plus Chain of Custody document(s). When the Laboratory Report is indicated as revised,this report supersedes any previously dated reports for the laboratory ID(s)referenced above. Where this report identifies subcontracted analyses,copies of the subcontractor's test report are available upon request. This report may not be reproduced,except in full,without written approval from Spectrum Analytical,Inc. Spectrum Analytical,Inc.is a NELAC accredited laboratory organization and meets NELAC testing standards.Use of the NELAC logo however does not insure that Spectrum is currently accredited for the specific method or analyte indicated.Please refer to our"Quality"web page at www.spectrum-analytical.com for a full listing of our current certifications and fields of accreditation.States in which Spectrum Analytical,Inc. holds NELAC certification are New York,New Hampshire,New Jersey and Florida.All analytical work for Volatile Organic and Air analysis are transferred to and conducted at our 830 Silver Street location(NY-11840,FL-E87936 and NJ-AM012). Headquarters:I 1 Ahngren Drive&830 Silver Street•Agawam,MA 0 100 1•1-800-789-9115•413-789-9018•Fax 413-789-4076 www.spectrum-analytical.com Page 1 of 16 e� Sample Identification Client Proiect# Matrix Collection Date/Time Received MW-5 V0990 Ground Water 21-Oct-11 11:45 26-Oct-11 SB38215-01 CAS No. Analyte(s) Result Flag Units "RDL MDL Dilution Method Ref. Prepared Analyzed Analyst Batch Cert Subcontracted Analyses Subcontracted Analyses Prepared by method 188328-MA VPH Analysis performed by Phoenix Environmental labs,Inc. *-CT007 7143-2 Benzene <1 ug/L 1 1 MA VPH 5/2004 02-Nov-11 02-Nov-11 MACTO 188328A C5-CB Aliphatic 1,200 ug/L 100 100 Hydrocarbons'1,2 C9-C10 Aromatic 960 ug/L 100 100 Hydrocarbons*1 C9-C12 Aliphatic 3,600 ug/L 100 100 " Hydrocarbons'1,3 10OA14 Ethyl Benzene 12 ug/L 1.0 1.0 106-42-3 m,p-Xylenes 64 ug/L 2.0 2.0 1634-044 MTBE <1 ug/L 1 1 91-20-3 Naphthalene 7 ug/L 5.0 5.0 " 95-47-6 o-Xylene 16 ug/L 1.0 1.0 108-88-3 Toluene 3.6 ug/L 1.0 1.0 Unadjusted C5-C8 1,200 ug/L 100 100 Aliphatics(`1) Unadjusted C9-C12 4,600 ug/L 100 100 Aliphatics(*I) Surrogate recoveries: 615-59-8 %2,5-Dibromotoluene 103 % (FID) 615-59-8 %2,5-Dibromotoluene 101 % (PID) This laboratory report is not valid without an authorized signature on the cover page. 10-Nov-11 11:26 *Reportable Detection Limit Page 5 of 16 Sample Identification Client Project# Matrix Collection Date/Time Received MW-5D V0990 Ground Water 21-Oct-I1 13:00 26-Oct-11 SB38215-02 CAS No. Analyte(s) Result Flag Units "RDL MDL Dilution Method Ref. Prepared Analyzed Analyst Batch Cert. Subcontracted Analyses Subcontracted Analyses Prepared by method 188328-MA VPH Analysis performed by Phoenix Environmental Labs,Inc. *-CT007 7143-2 Benzene <1 ug/L 1 1 MA VPH 5/2004 02-Nov-11 02-Nov-11 MACTO 188328A C5-C8 Aliphatic <100 ug/L 100 100 Hydrocarbons'1,2 C9-CIO Aromatic <100 ug/L 100 100 Hydrocarbons`1 C9-C12 Aliphatic <100 ug/L 100 100 Hydrocarbons'1,3 100414 Ethyl Benzene <1 ug/L 1 1 10642-3 m,p-Xylenes <2 ug/L 2 2 1634-044 MTBE <1 ug/L 1 1 " 91-20-3 Naphthalene <5 ug/L 5 5 95.47-6 o-Xylene <1 ug/L 1 1 108-88-3 Toluene <1 ug/L 1 1 Unadjusted C5-C8 <100 ug/L 100 100 Aliphatics('1) Unadjusted C9-C12 <100 ug/L 100 100 Aliphatics('1) Surrogate recoveries: 615-59-8 %2,5-Dibromotoluene 95 (FID) 615-59-8 %2,5-Dibromotoluene 94 % (PID) This laboratory report is not valid without an authorized signature on the cover page. 10-Nov-11 11:26 *Reportable Detection Limit Page 6 of 16 Sample Identification Client Project# Matrix Collection Date/Time Received MW-9 V0990 Ground Water 21-Oct-11 11:00 26-Oct-I I SB38215-04 CAS No. Analyte(s) Result Flag Units *RDL MDL Dilution Method Ref. Prepared Analyzed Analyst Batch Cert, Subcontracted Analyses Subcontracted Analyses Prepared by method 188328-MA VPH Analysis performed by Phoenix Environmental Labs,Inc. "-CT007 71-43-2 Benzene <1 ug/L 1 1 MA VPH 5/2004 02-Nov-11 02-Nov-11 MACTO 188328A C5-C8 Aliphatic <100 ug/L 100 100 " Hydrocarbons'1,2 C9-C10 Aromatic <100 ug/L 100 100 " Hydrocarbons*1 C9-C12 Aliphatic <100 ug/L 100 100 " Hydrocarbons'1,3 10041.4 Ethyl Benzene <1 ug/L 1 1 " 106-42-3 m,p-Xylenes <2 ug/L 2 2 " 1634-04-4 MTBE <1 ug/L 1 1 91-20-3 Naphthalene <5 ug/L 5 5 " 95-47-6 o-Xylene <1 ug/L 1 1 " IOB-88-3 Toluene <1 ug/L 1 1 " Unadjusted C5-C8 <100 ug/L 100 100 " Aliphatics('1) Unadjusted C9-C12 <100 ug/L 100 100 Aliphatics('1) Surrogate recoveries: 615-59-8 %2,5-Dibromotoluene 101 % " (FID) 615.59-8 %2,5-Dibromotoluene 99 % " (PID) This laboratory report is not valid without an authorized signature on the cover page. 10-Nov-11 11:26 *Reportable Detection Limit Page 8 of 16 ._....... '__.-- ..._...__ --._ ___..........._.. .......... .__._ — .._. 7.`.)C-' Spc,ciat Hand 17 ng: �� �� ❑ St�lnd 7rd F A r-7 to 1 o bttsmess days ( � CHAIN OF CUSTODY RECORD ❑ Rush .f.A I Date Needed: _ ,,,"„��3 �'���,I - All 7 A l'„object fo laboratory approval. Mm.21-hour ui)ti{icationlrlceded For rushes. srF:cTaum era�I v77cnt.,lac page _of Samples disposed"of after 60 days unless rrhn ;„x - otherwise instructed. . . II�NIa.�l,7'I:C'HNOt.(.1C:\' - '" -- - - - .—__ '—" - Report To: 1 y -- ('.t.4 V0 I°�yl�l t.?� ._ Projcc t No.: 4 r7. 0 lnvotcc To ___- - � _ic�- S i�r — - rl 4cf f( _�n�tticz ....._ . _.._.__ --- ° Site Name: •�-�\� --�'�`����c-1 �-�.� h�r�.------- !C.�c�___C.u��sS��� �Yc3l --— ,.r�!t�� r __ -- — - Lt iti f� l,ocaticm: -`.)_`5_k L!(2C4C.t1 �t�_State: -- �f�'.__.'t„_ lrr vr'i -JI,/��1a --- -- Telephone#: _ -- P.O.No.: '�#i C �, RQN S unplu(�) _ Project Mgr. - - �/lu\ret .... lt_�4t 1 1=Na,,S20J 2 HCl .3 I12SO., 4-HNO3 5=NaOH 6-Ascorbic Acid 7=C.11JOff fist .ieservatvecodw elow.. Q;e,/QC Report)ng`Notes 8=NaHSG.1 9=Deionized Water 10=. .._-- l l ! ddul$nal ch71g miy apply .,: D\�=D)inkingWater CiW=Groundwater WW=Wastewater Containers Analyse MAnerMCPCAroIRopor(:ves❑No❑ O=Oil SW-Surface Water SO°=Soil S1..=Sludge A=Air C.rDillIRCPRcpon:Yes❑No❑ X 1= X-'=..._.........:__....-----............ 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E-mail to /L'1-S�CJU/69�tyl U'L'. e / tea ` l�i�'( r CEI, .r� , • 1�1a 1,1 Y t- ❑An)blent'❑1a(1❑RrFn6entHd EJ Fndge t ri,p C tG1 Freer ie+r p 1 t A -fLicn Drivc•Agawam,MA 01001.41.3-789-9018•FAX 413-789-4076•w�iw_syecn_um u7alyt.ic.�l,c(>rrl RcviscaJ°b' oIo a9�oes PoSrA:, A-Meffmaw • 2 PITNEY BOWES 02 1 P $ 005.990 7009 008-0 0001 7582 5930 0004411988 DEC 29 2011 MAILED FROM ZIP CODE 01 460 1 Speen Street, Suite 200, Framingham, MA 01701 ( KL E/NFEL DER \\ /Bright People.Right solutions. Town of Barnstable 367 Main Street Hyannis, MA 02601 Number Fee 1130 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS #2142 395 WEST MAIN STREET, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Ll � - Town of Barnstable oftHE r � Regulatory Services Richard V. Scala, Director RAWMMAS&AB ' ` Public Health D VISlon Aifa ,9. Thomas McKean, Director 200 Maio Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.60 , ASSESSORS MAP AND PARCEL NO. 269 - 116 DATE 06/17/2014 APPLICATION FOR-PERIMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Cumberland Farms, Inc. NAME OF ESTABLISHMENT Cumberland Farms #2142 ADDRESS OF ESTABLISHMENT 395 West Main St/Suomi Rd (Rte 28), Hyannis, MA TELEPHONE NUMBER 508-790-0227 SOLE OWNER: X YES NO IF APPLICANT IS A PARTNERSI1aPj FULL NAME AND HOME ADDRESS OF ALL PARTNERS: N/A IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO, 04-2843586 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OE;. Please see attached . PRESIDENT TREASURER I CLERK Authorized Rep.) SIG=APPLICANT RESTRICTIONS: HOME ADDRESS c/o EC88 Silver St., Agawam, MA HOME TELEPHONE# N/A 01001 Q:\Application Forms\HAZAPP.DOC l . FARMSQmaiand Date of Incorporation: September 14, 1984 State of Incorporation: Delaware Principal Address: 100 Crossing Boulevard, Framingham, MA 01702 Office Telephone: 508-270-1400 . PRINCIPAL OFFICERS: Ari N. Haseotes President& Group Chief Operating Officer Howard S. Rosenstein Treasurer Mark G. Howard, Esq. Secretary John T. Daly Assistant Treasurer Diane M. Boissonneault Assistant Secretary Cumberland Gulf Group of Companies 100 Crossing Boulevard,Framingham,MA 01702 508-270-1400 { Town of Barnstable °FTHE T � Regulatory Services * Richard V. Seah, Director t BAMSTABIZ, Pudic Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J. Cmmiff,D.M.D. Junichi.Sawayanab NOTICE TO ALL BUSINESS OPERATORS WIITH HAZARDOUS MATERULS IN BARNSTA 3LE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular site. STEPS 1 —2 - 3: 1. Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on or before June 30, 20.14. A date charge of$10.00 will be assessed if payment is not received by July 30, 2014, Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, vww.town.barnsta-ble.ma.us , which is located under the E-Code section if you should have any questions or concerns. Q:1Hazmat\Haz Mat Permit Letter.DDC i i MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601. FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q:1AppGcation Forms\HAZAPP.DOC Emergency Response Plan Table of Contents Section Page(s) 1.0 Purpose 1 2.0 Responsibilities 2 3.0 Emergency Action Procedures 39495 4.0 Emergency Response Plan 697 5.0 Training 7 6.0 Potential Hazards Of.Substances In An 8 Emergency Emergency Pump Valves L Appendix A 1.0 Purpose: The Retail Emergency Response Plan provides information necessary to respond correctly in case of an emergency, such as a fire or fuel spill. OSHA (Occupational Safety and Health Administration) standard 1910.120 requires that every working establishment maintain a copy of the Emergency Response Plan on the premises at all times. 2.0 Responsibilities: The Store Manager is the Emergency Coordinator for the store. In the absence of the Store Manager, the head employee on duty will be the Emergency Coordinator. Emergency Coordinators are responsible for first response to emergencies, steps following under section 3.0 of these procedures. Store management is also responsible for training employees as defined in section 5.0 of these procedures. 3.0 Emergency Action Procedures: Guidelines for emergency response are outlined.on the "Yellow Emergency Response Card", which is to be posted near the telephone. This provides the details of this plan. 3.1 In case of an emergency involving a fuel spill,fire, propane or natural gas leak: 3.1.1 Follow immediate response procedures in the event of a: Gasoline Leak at Pumps 3.91 Fire at Gas Pumps 3.92 Fire at Other Location 3.93 CO2 Alarm sounds 3.94. 5/13 1 of 8 Emergency Response Plan 3.2 Evacuate the property for a fire or serious fuel spill (25 gallons or more), propane or natural gas leak. 3.2.1 Customers are to be evacuated from the property. 3.2.2 Send fellow employees to the Safe Meeting area. 3.2.3 For smaller spills, the area of the spill is to be restricted from customers. 3.3 Call for Help 3.3.1 Use the numbers listed on the "Yellow Emergency Response Card" 3.3.2 Call the Fire Department for all fires, regardless of the size, for all gasoline spills, and propane or natural gas leaks. 3.3.3 Call for an ambulance when outside medical help is needed. 3.3.4 Use the Calling Procedures on the "Yellow Emergency Response Card"to ensure that the correct information is provided. 3.4 Secure the facility 3.4.1 If safe to do so, lock the store during the evacuation. 3.4.2 If local authorities need entrance,provide assistance or guidance to unlock the facility. 3.5 .Restrict pedestrian and vehicular traffic 3.5.1 Restrict all pedestrian and vehicular traffic from the entire area in the event of spills or fires. 3.5.2 For smaller spills, traffic must be restricted from the area of the spill. 3.5.3 For smaller fires that can be handled by a fire extinguisher, customers must be restricted from the store, or if outside, from the area of the fire. 3.5.4 Use yellow caution tape, or use any type of barricade to prevent pedestrian and vehicular traffic from entering the property. 3.6 Do not to attempt to clean up any major blood spill or gasoline spill too large for you to handle! 3.6.1 Do not risk your health to contain, control or clean up a spill. Your safety is of the utmost concern. 3.6.2 Trained professionals will take care of this. They have the proper equipment to handle these situations. 3.7 Go to the Safe Meeting Area Identified for your Store on the "Yellow Emergency Response Card" 3.7.1 If the situation is beyond your control, go to the pre-determined safe location for your store. 5/13 2 of 8 Emergency Response Plan 3.7.2 When local authorities arrive identify yourself to let them know that the store employees are safe. You can also assist them with information about the situation. 3.7.3 All store employees are required to go to this safe location in an evacuation situation. 3.8 Call Cumberland Farms Management 3.8.1 When you are out of danger, you must call the Store Manager(if not present) or the Area Sales Manager. 3.8.2 You must also call the Risk Management Department#provided on the "Yellow Emergency Response Card". 3.9 Immediate Emergency Action Procedures 3.9.1 Leak at the Gas Island Problem EmerLyency Action 1. Leak from the A)Depress the hose number and then the PUMP STOP button. hose/nozzle NOTE: This will only stop the one problem hose/nozzle. B) If the flow of gasoline doesn't stop depress the RED EMERGENCY STOP button. 2. Leak at pump A) Depress the RED EMERGENCY STOP button. NOTE: This will stop ALL pumps. ' B) If the problem continues, shut off the breaker for the problem produ in the Electrical Breaker Box(s) marked "Emergency Gas Breakers Inside ". This will shut off the submersible turbine pump (STP) for tha product. C) If the problem continues shut off ALL of the breakers in the box(s). Call Facility Support Services. 3. Leak within the 1. Remove the front lower panel on the dispenser. pump. NOTE: In 2. Trip the Crash/Shear valve (refer to Appendix A). this situation, the 3. Depress any of the hose.number buttons to turn the console back leak is between the on. crash/shear valve 4. Re-check for leak; if OK, replace panel. and the totalizer. 5. Call Facility Support Services. 5/13 3 of 8 Emergency Response Plan 3.9.2 Fire at the Gas Island Problem Emer enc Action 1. Fire at Pump A) Pull FIRE PULL once, and push EMERGENCY BUTTON. (s) NOTE: This will empty the fire suppression bottles completely. This will also stop all of the gas pumps. B) After fire suppression system has stopped corn 1p etely, shut off all power(ALL breakers within the breaker box marked"Emergency Gas Breakers Inside ". C) Call the Fire Department. D Call your Supervisor and Facility Support Services. 3.9.2 Fire at Other Locations Problem Emergency Action 1. Fire located other than Call the fire department. If the fire is small and controllable, Gas Island. use a fire extinguisher. 3.9.3 CO2 Alarm Problem Emergency Action 1. CO2 Alarm 1 Indicator Alarm 1 (low level) light is on and alarm sounds Do. Not enter flashes and buzzer the syrup pumping area and any employees in this area are to sounds immediately leave area. Proceed to the bulk CO2 tank and turn supply valve identified with brass tag counter clockwise to the off position. Immediately contact facility support services. Do Not enter syrup pumping area until alarm stops. 2. CO2 Red Alarm 2 Alarm 1 and.2 lights are on and the alarm is sounding faster Indicator flashes and (high level) employees are to Evacuate as a high level of alarm buzzer sounds could indicate a catastrophic leak that can generate extremely hazardous CO2 levels. Secure the store. Go to the Safe Meeting Location. Do Not enter the Syrup, Pumping area. Immediately contact Fire Department, and then contact Store Maintenance. 5/13 4 of 8 Emergency Response Plan 4.0 Emergency Response Plan: The following are the company guidelines,which parallel OSHA requirements. They are placed in the same sequence and headed in the same wording as they ..appear in OSHA Standard 1910.120. 4.1 Pre-Emergency Planning: States, along with designated districts within the states, have developed their own plans. The Store Manager should contact the local fire department for review of your plan to ensure that it is compatible with theirs. The fire department will also advise and record the safe location for your store in the event that store personnel must be evacuated. By doing this,they will know where to go to account for missing store personnel. They can also advise you concerning emergency medical supplies and methods. 4.2 Personnel Roles, Lines of Authority and Communication: The Store Manager is the Emergency Coordinator for the store. In the absence of the Store ' Manager, the lead employee on duty will be the Emergency Coordinator. Emergency Coordinators are responsible for the implementation of the Emergency Response Plan, and must perform all duties described within it. Emergency Coordinators are responsible for contacting the local Fire Department, the Store Manager if necessary,the Area Sales Manager,the originating Gulf fuel terminal (in the event of a spill by a tanker), the Environmental and Risk Management Departments per directions on"Yellow Emergency Response Card". 4.3 Emergency Recognition and Prevention: The Store Manager (or designee) must inspect(daily or weekly)the gasoline hoses for defects such as cracks or slices to prevent rupture. If a defect is found contact Facility Support Services. If needed,the gasoline pump will be placed out of service until the problem is repaired. When a gasoline delivery is being made, the delivery driver is responsible for the hazards that are inherent with that type of operation. If an emergency does occur, the Emergency Coordinator will follow the responsibilities as outlined in the Emergency Response Plan. [Gasoline.is identified as clear to orange tinted in color, and having a strong hydrocarbon odor]. 4.4 Safe Distances and Places of Refuge: If a fire or spill is of a serious nature and endangers human life, you are to evacuate the location, directing all occupants to your designated "safe location". The local Fire Department can assist you in determining the most appropriate safe location for your store. In general, it will be a location away from the building, possibly where a telephone is available. It should be in sight of the premises, so that you can readily identify yourself to authorities responding to the scene. The location for this store is 5/13 5 of 8 Emergency Response Plan 4.5 Site Security and Control: In the event of a serious fire or spill,pedestrian and vehicular traffic must be restricted from the entire area. For smaller spills that pose no danger, traffic should be restricted from the area of the spill until clean up has occurred. For smaller fires that can be handled by a hand-held fire . extinguisher, customers must be restricted from the store or area of the fire. Yellow tape, ropes, barrels, etc. are to be used to restrict traffic. 4.6 Evacuation Routes and Procedures: The local Fire Department can assist you in determining the preferred evacuation route to your safe location in the event of a fire or spill. In general, our stores offer immediate access to the outside of our buildings through the emergency exit doors. The most direct route to your safe place should then be followed. Each store manager is responsible for establishing a Safe Meeting Place, training all employees on its location and notifying local authorities of its location. 4.7 Decontamination: This is the process of removing or neutralizing contaminants that have accumulated on personnel and equipment. It is critical to the health and safety of those involved in one of these incidences. Decontamination will be implemented by trained personnel (the company that cleans up and disposes of spills). 4.8 Emergency Medical Treatment and First Aid: If a serious injury is involved, appropriate medical personnel should be summoned immediately. This can be done via your telephone call to the local Fire Department. Otherwise, in the event of a minor injury,the store first aid kit is available Call your area Sales Manager and then Risk Management for major blood spills. 4.9 Emergency alerting and response procedures: Follow the Emergency Action Procedures as outlined in this Plan. 4.9.1 Critique and follow up: When the emergency is over,all information regarding the occurrence should be retained. This will be used to determine if the emergency was avoidable,and if so,how. A determination will also be made regarding whether appropriate steps were taken to minimize the loss.If necessary,the program will be reviewed for any changes required. 4.10 Personal protective equipment and emergency equipment: When applicable you will be handling, containing, controlling and cleaning up small gasoline spills. While conducting these actions please make sure to wear latex or rubber gloves to limit 5/13 6 of 8 Emergency Response Plan your exposure and follow proper disposal requirements (Yellow Spill Bucket). In the event of a fire, an extinguisher should only be used on small, controllable fires. Otherwise,.the Fire Department will handle a fire. 5.0 Training: Store management is responsible for training store employee on this plan upon initial assignment and annually thereafter. Retail employees of Cumberland Farms, Inc. must be trained at the first responder awareness level and as a Class C UST Operator. First responders at the awareness level are individuals who are likely to witness or discover a hazardous substance release, and must be trained to: 5.1 Understand what hazardous substances are and the risks associated with them. 5.2 Understand the potential outcomes associated with an emergency created when hazardous substances are present. 5.3 Recognize the presence of hazardous substances in an emergency. 5.4 Identify the hazardous substances, if possible. 5.5 Understand the role of the first responder awareness individual. 5.6 Recognize the need for additional resources, and to make appropriate notifications as outlined in this Plan. 6.0 Potential Hazards of Substances in an Emergency: 6.1 Fires or Explosion. 6.1.1 Gasoline is a Flammable liquid. Propane and natural gas are flammable gases. Heat sparks or flames may ignite these 6.1.2 Vapors from these substances may travel to a source of ignition and flash back. 6.1.3 Containers may explode in the heat of a fire. 6.1.4 Runoff to sewer may create fire or explosion hazard. 6.2 Health Hazards 6.2.1 May be poisonous if inhaled or absorbed through skin. 5/13 7 of 8 Emergency Response Plan 6.2.2 Vapors may cause dizziness or suffocation. 6.2.3 Contact may irritate or burn skin and eyes. 6.2.4 Fire may produce irritating or poisonous gases. 6.2.5 Runoff from fire control or dilution water may cause pollution. 6.3 Emergency Action (D.O.T. Department of Transportation Guidelines) Spills 6.3.1 Keep unnecessary people away; isolate hazard area and deny entry. 6.3.2 Stay upwind; keep out of low areas. 6.3.3 (Emergency authorities only) Self-contained breathing apparatus (SCBA) and structural firefighter's protective clothing will provide limited protection. 6.3.4 Isolate area for 1/2 mile in all directions if tank car or truck is involved in fire. 6.3.5 (Environmental personnel only) Call Chemtrec at 1-800-424-9300 for emergency assistance. If water pollution occurs, notify the proper authorities. 6.4 Fire Fighting Guidelines (for fire departments) 6.4.1 Small fires: dry chemical, CO2, Halon, water spray or standard foam. 6.4.2 Large fires: water spray,fog or standard foam is recommended. 6.4.3 Move containers from fire area if you can do so without risk. For cooling containers that are exposed to flames with water from the side until well after ire is out. 6.4.4 STAY AWAY FROM ENDS OF TANKS, AS THEY CAN BLOW OUTWARDS. For massive fire in a cargo area,use unmanned hose holder or monitor nozzles; if this is impossible, withdraw from area and let fire burn. Withdraw immediately in case of rising sound from venting safety device or any discoloration of tank. 5/13 8 of 8 f Cum 'itd Fauns Date: 02-21-08 To: Hyannis Board of Health Attention: Thomas McKean Sharon Crocker From: Cumberland Farms Rick Boyle, Region Manager, Steve Alongi, Area Sales Manager Subject: Cumberland Farms 389 W. Main St. Hyannis Store/ Station 2326/2142 This is to inform you of the status of the Gasoline Underground Storage Tanks Daily test results. The results for the month of January 2008, all state passing results on a daily basis. These test results are on file at the Cumberland Farms Regional Office located at 393 W. Main Street in Hyannis, phone number (508) 778 — 2709. The daily certified results are available for view at any time. Please contact us if there are any questions. Thank you for your cooperation. W Cc: Kathleen Souza C (^' V Ili err Cumber "ncl Farms Date: 10-12-07 To: Hyannis Board of Health _ Attention: Thomas McKean Sharon Crocker From: Cumberland Farms Rick Boyle, Region Manager, Steve Alongi, Area Sales Manager Subject: Cumberland Farms 389 W. Main St. Hyannis Store/Station 2326/2142 This is to inform you of the status of the Gasoline Underground Storage Tanks Daily test results. The results for the month of October 2007, all state passing results on a daily basis. These test results are on file at the Cumberland Farms Regional Office located at 393 W. Main Street in Hyannis, phone number (508) 778 — 2709. The daily certified results are available for view at any time. Please contact us if there are any questions. Thank you for your cooperation. E Cc: Kathleen Souza ry �: rn M i; AECOM AECOM Environment 95 State Road,Sagamore Beach,MA 02562-2415 T 508.888.3900 F 508.888.6689 www.aecom.com February 2, 2009 AECOM File: 02140-251 Town of Barnstable Board of Health 367 Main Street Hyannis, MA 02601 RE: Laboratory Analytical Results Cumberland Farms, Inc. Facility#2142 395 West Main Street Hyannis, Massachusetts Release Tracking Number 4-14257 To Whom It May Concern: This letter is intended to satisfy the public involvement requirements outlined in the Massachusetts Contingency Plan (MCP)310 CMR 40.1400. AECOM Environmental (AECOM) is providing environmental consulting services to our client, Cumberland Farms, Inc. (CFI), at the above-referenced facility with respect to Release Tracking Number(RTN)4-14257 assigned by the Massachusetts Department of Environmental Protection (DEP). On January 8, 2009,AECOM collected groundwater samples from monitoring wells situated in the town right of way on Soumi Road. Pursuant to the MCP 310 CMR 40.1403(10)(b), please find enclosed a copy of the laboratory analytical report. In addition, AECOM has written this letter to inform you of the proposed field schedule related to collection of environmental samples from your property pursuant to 310 CMR 40.1403(10)(a). This work is dti1,rently; under the same sample schedule as established previously; however, per current regulations we a, required to provide a written communication for your records. This work will involve the collection. =` groundwater samples from monitoring wells on your property on a quarterly basis, with e�c ct datescO dependent on weather conditions. Pursuant to 310 CMR 40.1403(10)(b), AECOM will pr�oide samer results from the quarterly sampling events within 30 days of the date the sample results ax, issued by the laboratory. CD ­0 7--- In addition, pursuant to the MCP 310 CMR 40.1403(10)(b), this letter is intended to inform y u that u lic co involvement opportunities are available under the MCP 310 CMR 40.1403(9)and 310 CMR 0.140 f yoV have any questions, please contact Anne Blais of CFI at(800)225-9702 extension 3417 or a undersigned. Sincerely yours, "� . -rt:�4e�z Brian D. Serrecchia Melissa J. )annon Project Manager CFI Program Manager cc:Anne Blais- CFI Town of Barnstable Public Notification- 251_AECOM.doc NOTICE OF ENVIRONMENTAL SAMPLING As required by 310 CMR 40.1403(10) of the Massachusetts Contingency Plan BWSC 123 This Notice is Related to Release Tracking Number 4� 14257 A. The address of the disposal site related to this Notice and Release Tracking Number(provided above): 1. Street Address: 395 West Main Street City/Town: Hyannis Zip Code: 02601 B. This notice is being provided to the following party: 1. Name: Town of Barnstable 2. Street Address: 367 Main Street City/Town: Hyannis Zip Code: 02601 C. This notice is being given to inform its recipient(the party listed in Section B): ❑✓ 1. That environmental sampling will be/has been conducted at property owned by the recipient of this notice. ✓❑2. Of the results of environmental sampling conducted at property owned by the recipient of this notice. ✓❑3. Check to indicate if the analytical results are attached. (If item 2. above is checked, the analytical results from the environmental sampling must be attached to this notice. D. Location of the property where the environmental sampling will be/has been conducted: 1. Street Address: Suomi Road City/Town: Hyannis Zip Code: 02601 2. MCP phase of work during which the sampling will be/has been conducted: ❑Immediate Response Action ❑ Phase III Feasibility Evaluation ❑Release Abatement Measure ❑ Phase IV Remedy Implementation Plan ❑Utility-related Abatement Measure ✓❑ Phase V/Remedy Operation Status ❑Phase I Initial Site Investigation ❑ Post-Class C Operation, Maintenance and Monitoring ❑Phase II Comprehensive Site Assessment ❑ Other (specify) 3. Description of property where sampling will be/has been conducted: ❑residential []commerical ❑industrial ❑school/playground ❑✓ Other right of way (specify) 4. Description of the sampling locations and types (e.g., soil, groundwater)to the extent known at the time of this notice. Groundwater samples were collected from monitoring wells situated in the right of way of Suomi Road. E.Contact information related to the party providing this notice: Contact Name: Christopher Johnson Street Address: 777 Dedham Street City/Town: Canton Zip Code: 02021 Telephone: (800)225-9702 Email: cjohnson@cumberiandfarms.com NOTICE OF ENVIRONMENTAL SAMPLING As required by 310 CMR 40.1403(10) of the Massachusetts Contingency Plan MASSACHUSETTS REGULATIONS THAT REQUIRE THIS NOTICE This notice is being provided pursuant to the Massachusetts Contingency Plan and the notification requirement at 310 CMR 40.1403(10). The Massachusetts Contingency Plan is a state regulation that specifies requirements for parties who are taking actions to address releases of chemicals (oil or hazardous material) to the environment. THE PERSON(S) PROVIDING THIS NOTICE This notice has been sent to you by the party who is addressing a release of oil or hazardous material to the environment at the location listed in Section A on the reverse side of this form. (The regulations refer to the area where the oil or hazardous material is present as the "disposal site'.) PURPOSE OF THIS NOTICE When environmental samples are taken as part of an investigation under the Massachusetts Contingency Plan at a property on behalf of someone other than the owner of the property, the regulations require that the property owner (listed in Section B on the reverse side of this form) be given notice of the environmental sampling. The regulations also require that the property owner subsequently receive the analytical results following the analysis of the environmental samples. Section C on the reverse side of this form indicates the circumstance under which you are receiving this notice at this time. If you are receiving this notice to inform you of the analytical results following the analysis of the environmental samples, you should also have received, as an attachment, a copy of analytical results. These results should indicate the number and type(s) of samples (e.g., soil, groundwater) analyzed, any chemicals identified, and the measured concentrations of those chemicals. Section D on the reverse side of this form identifies the property where the environmental sampling will be/has been conducted, provides a description of the sampling locations within the property, and indicates the phase of work under the Massachusetts Contingency Plan regulatory process during which the samples will be/were collected. FOR MORE INFORMATION Information about the general process for addressing releases of oil or hazardous material under the Massachusetts Contingency Plan and related public involvement opportunities may be found at http://www.mass.gov/dep/cleanup/oview.htm. For more information regarding this notice, you may contact the party listed in Section E on the reverse side of this form. Information about the disposal site identified in Section A is also available in files at the Massachusetts Department of Environmental Protection. See http://mass.gov/dep/about/region/schedule.htm if you would like to make an appointment to see these files. Please reference the Release Tracking Number listed in the upper right hand corner on the reverse side of this form when making file review appointments. . i I i E e t i i i J 0- k Geol kbs.lite. Wednesday, January 14, 2009 i ' 3 I GeoLabs, Inc. 1 BRIAN SERRECCHIA 45 Johnson Lane E ENSR Braintree MA 02184 95 State Road Tele: 781 848 7844 Sagamore Beach, MA 02562-2415 Fax: 781 848 7811 j I TEL: (508)888-3900 FAX: Project: CFI 2142, 02140251 Location: 395 W Main St Hyannis, MA Order No.: 0901079 i i Dear BRIAN SERRECCHIA: . E GeoLabs, Inc. received 11 sample(s) on 1/9/2009 for the analyses presented in the following report. I i I There were no problems with the analyses and all data for associated QC met EPA or i laboratory specifications. Analytical methods and results meet requirements of 310CMR 40.1056(J) as per MADEP Compendium of Analytical Methods (CAM). If you have any questions regarding these tests results, please feel free to call. Sincerely, i - f - E Jim Chen Laboratory Director i r For current certifications,please visit our website at www.geolabs.com Certifications: CT(PH-0148).-.MA(M-MA015)- NH(2508)-NJ(MA009)-NY(11796)-RI(LA000252) I E i I I G } y { GeoLabs, Inc. Date: 14-Jan-09 CLIENT: ENSR Project: CFI 2142,02140251 CASE 1\N DATIVE ; Lab Order: 0901079 MADEP MCP Response Action Analytical Report Certification Form Laboratory Name: GeoLabs, Inc. Project# 02140-251 Project Location: CFI 2142 MADEP RTN#: This form provides certification for the following data set: 0901079 (001-011) I 5 Sample Matrix: Groundwater I MCP Methods Used: VPH An affirmative answer to questions A, B, C and D are required for"Presumptive Certainty" status A. Were all samples received by the laboratory in a condition consistent with that described on the Chain of custody documentation for the data set? YES r B. Were.all QA/QC procedures required for the specified method(s) included in this report followed, including the requirement to note and discuss in a narrative_QC data that did not meet appropriate i standards or guidelines? YES f C. Does the analytical data included in this report meet all the requirements for"Presumptive Certainty" as described in Section 2.0 of the MADEP documents CAM VII A"Quality Assurance.and Quality Control Guidelines for the Acquisition and Reporting of Analytical Data"? YES D. VPH and EPH Methods only: Was the VPH or EPH Method conducted without significant .modifications (see Section 11.3 of respective Methods) YES A response to questions E and F are required for"Presumptive Certainty" status E. Were all QC performance standards and recommendations for the specified methods achieved? YES F. Were results for all analyte-list compounds/elements for the specified method(s)reported? YES { All NO answers need to be addressed in an attached Environmental Laboratory case narrative. I I i Page 1 of 3 i 4 r CLIENT: ENSR Project: CFI 2142,02140251 I � Lab Order: 0901079 CASE NARRATIVE k t L CASE NARRATIVE Ft Physical Condition of Samples The project was received by the laboratory in satisfactory condition. The sample(s)were received undamaged, in appropriate containers with the correct preservation. Project Documentation k The project was accompanied by satisfactory Chain of Custody documentation. Analysis of Sample(s) 4 No analytical anomalies or non-conformances were noted by the laboratory during the processing of I these samples. ` i I the undersigned, attest under the pains and penalties of e ' that based upon m personal inquiry� � p p p rJ�' � p Y p q rY of those responsible for obtaining the.information, the material contained in this analytical report is, to I the best of my knowledge and belief, accurate and complete. I Signature: >"' Position: Lab Director Printed Name: 'Jim Chen Date: 01/14/09 t i i { Page 2 of 3 { ' E 4 i • j E CLIENT: ENSR Project: CFI 2142,02140251 CASE NARRATIVE Lab Order: 0901079 VPH Methods Method for Ranges: MADEP VPH 04-1.1 Method for Target Analytes: MADEP VPH 04-1.1 Carbon Range data exclude concentrations of any surrogate(s) and/or internal standards eluting in that range. C5-C8 Aliphatic Hydrocarbons exclude the concentration of Target Analytes eluting in that range. (MTBE, Benzene, Toluene) C9-C 12 Aliphatic Hydrocarbons exclude concentration of Target Analytes eluting in that range (Ethylbenzene, m&p-Xylenes, o-Xylene) AND concentration of C9-C10 Aromatic Hydrocarbons. j 1 CERTIFICATION Were all QA/QC procedures REQUIRED by the VPH Method followed? YES j Were all QA/QC performance/acceptance standards achieved? YES Were any significant modifications made to the VPH method, as specified in Sec. 11.3? NO I I attest under the pains and penalties of perjury that,based upon my inquiry of those individuals immediately responsible for obtaining the information, the material contained in this report is, to the best of my knowledge, accurate and complete. j SIGNATURE: POSITION: LAB DIRECTOR I PRINTED NAME: Jim Chen DATE: 01/14/09 k !j } i i j Page 3 of 3 i i 4 r i 6 r. t GeoLabs, Inc. Date: 14-Jan-09 Work Order Sample Summary CLIENT: ENSR Project: CFI 2142,02140251 Lab Order: 0901079 Location: 395 W Main St Hyannis,MA Lab Sample ID Client Sample ID Matrix Co llection f Date Date Received i 0901079-OOIA MW-1 Groundwater 1/9/2009 1:50:00 PM 1/9/2009 0901079-002A MW-3 Groundwater 1/9/2009 1:55:00 PM 1/9/2009 0901079-003A MW-4 Groundwater 1/9/2009 2:00:00 PM 1/9/2009 f{ 0901079-004A MW-5 Groundwater 1/9/2009 2:05:00 PM 1/9/2009 ! 0901079-005A MW-SD Groundwater 1/9/2009 2:10:00 PM 1/9/2009 ` 0901079-006A MW-6 Groundwater 1/9/2009 2:15:00 PM 1/9/2009 0901079-007A MW-7 Groundwater 1/9/2009 2:20:00 PM 1/9/2009 0901079-008A MW-8. Groundwater 1/9/2009 1:45:00 PM 1/9/2009 0901079-009A MW-9 r Groundwater 1/9/2009 1:40:00 PM 1/9/2009 0901079-OIOA DUP Groundwater 1/9/2009 2:20:00 PM 1/9/2009 0901079-011A Trip Blank Other 1/9/2009 i i t 4 i I • i I I 1 t i 7 i �ff 1 i i i f k i i I i I i i i i i 3 i i GeOLabS, Inc. Reported Date: 14-Jan-09 CLIENT: ENSR Client Sample ED: MW-5 Lab Order: 0901079 Collection Date: 1/8/2009 2:05:00 PM Project: CH 2142,02140251 Date Received: 1/9/2009 €€ Lab ID:- 0901079-004 Matrix: GROUNDWATER E Analyses Result Det.Limit Qual Units DF Date Analyzed VPH-MADEP VPH Analyst: kd I C9-C10 Aromatic Hydrocarbons 306 15.0 L 1 1/13/2008 Y p9/ UnadjustedC5-C8 Aliphatic 180 75.0 L 1 1/13/2008 f p p9/ f Hydrocarbons ; Unadjusted C9-C12 Aliphatic 1050 75.0 pg/L 1 1/13/2008 Hydrocarbons A4ethyl Tert-Butyl_Ether ND 5.00 pg/L 1 1/13/2008 Benzene ND 5.00 pg/L 1 1/13/2008 i Toluene. ND 5.00 pg/L 1 1/13/2008 Ethylbenzene 21.1 5.00 pg/L 1 1/13/2008 j m,p-Xylene 122 5.00 pg/L 1 1/13/2008 i o-Xylene 44.9, 5.00 pg/L 1 1/13/2008 Naphthalene ND 20.0 pg/L 1 1/13/2008 Adjusted C5-C8 Aliphatic 180 75.0 pg/L 1 1/13/2008 Hydrocarbons Adjusted C9-C12Aliphatic 556 75.0 pg/L 1 1/13/2008 Hydrocarbons f Burr:2,5-Dibromotoluene FID 125 70-130 %REC 1 1/13/2008 Surr:2,5-Dibromotoluene PID 80.1 70-130 %REC 1 1/13/2008 { f • f IIf f 1 i i t I i i I i i f i t 4 4 Qualifiers: B Analyte detected in the associated Method Blank BRL Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit S Spike Recovery outside recovery limits Page 4 of 11 f 6 1 GeoLabs, Inc. Reported Date: 14-Jan-09 CLIENT: ENSR Client Sample ID: MW-5D Lab Order: 0901079 Collection Date: 1/8/2009 2:10:00 PM Project: CFI 2142,02140251 Date Received: 1/9/2009 Lab ID: 0901079-005 Matrix: GROUNDWATER i Analyses Result Det.Limit Qual Units DF Date Analyzed VPH-MADEP VPH Analyst: kd C9-C10 Aromatic Hydrocarbons ND 75.0 pg/L 1 1/13/2008 Unadjusted C5-C8 Aliphatic _ ND 75.0 pg/L 1 1/13/2008 j Hydrocarbons Unadjusted C9-C12 Aliphatic ND 75.0 pg/L 1 1/13/2008 ; Hydrocarbons Methyl Tert-Butyl Ether ND 5.00 pg/L 1 1/13/2008 Benzene ND 5.00 pg/L 1 1/13/2008 Toluene ND 5.00 pg/L, 1 1/13/2008 Ethylbenzene ND 5.00 pg/L 1 1/13/2008 i m,p-Xylene . ND 5.00 pg/L 1 1/13/2008 o-Xylene ND 5.00 pg/L 1 1/13/2008 Naphthalene ND 20.0 pg/L 1 1/13/2008 Adjusted C5-C8 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons Adjusted C9-C12 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons Surr:2,5-Dibromotoluene FID 111 70-130 %REC 1 1/13/2008 Surr:2,5-Dibromotoluene PID 88.2 70-130 %REC 1 1/13/2008 1 E I i I i i E .. 1. I i 4 I I Qualifiers: B Analyte detected in the associated Method Blank BRL Below Reporting Limit i E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit S Spike Recovery outside recovery limits Page 5 of 11 i i I C i ♦ 1 GeOLabs, Inc. Reported Date: 14-Jan-09 i CLIENT: ENSR Client Sample ID: MW-6 Lab Order: 0901079 Collection Date: 1/8/2009 2:15:00 PM Project: CFI 2142,02140251 Date Received: 1/9/2009 Lab ID: 0901079-006 Matrix: GROUNDWATER i Analyses Result Det.Limit Qual Units DF Date Analyzed VPH-.MADEP VPH Analyst: kd q C9-C10 Aromatic Hydrocarbons ND 75.0 pg/L 1 1/13/2008 Unadjusted C5-C8 Aliphatic ND .75.0 pg/L 1 1/13/2008 Hydrocarbons Unadjusted C9-C12 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons 1 1 Methyl Tert-Butyl Ether ND 5.00 pg/L 1 1/13/2008 Benzene ND 5.00 pg/L 1 1/13/2008 Toluene ND 5.00 pg/L 1 1/13/2008 Ethylbenzene ND 5.00 pg/L 1 1/13/2008 m,p-Xylene ND 5.00 pg/L 1 1/13/2008 o-Xylene ND 5.00 pg/L 1 1/13/2008 Naphthalene ND 20.0 pg/L 1 1/13/2008 _ 1/13/2008 5 8 Aliphatic ND 75.0 /L 1 Adjusted C C p9 1 P j Hydrocarbons 3 Adjusted C9-C12 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons r Surr:2,5-Dibromotoluene FID 115 70-130 %REC 1 1/13/2008 Surr:2,5-Dibromotoluene PID 81.2 70-130 %REC 1 1/13/2008 � 1 I f f ! t I F Qualifiers: B Analyte detected in the associated Method Blank BRL Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit S Spike Recovery outside recovery limits Page 6 of 11 I 1 E s f GeoLabs, Inc. Reported Date: 14-Jan-09 { CLIENT: ENSR Client Sample ID: MW-7 Lab Order: 0901079 Collection Date: 1/8/2009 2:20:00 PM Project: CFI 2142,02140251 Date Received: 1/9/2009 Lab ID: 0901079-007 Matrix: GROUNDWATER 'Analyses Result Det.Limit Qual Units DF Date Analyzed VPH-MADEP VPH Analyst: kd C9-Cl0 Aromatic Hydrocarbons ND 75.0 pg/L 1 1/13/2008 Unadjusted C5-C8 Aliphatic ND 15.0 pg/L 1 1/13/2008 i Hydrocarbons Unadjusted C9-C1_2 Aliphatic 149 75.0 pg/L 1 1/13/2008 l Hydrocarbons Methyl Tert-Butyl Ether ND 5.00 pg/L 1 1/13/2008 Benzene ND 5.00 pg/L 1 1/13/2008 f Toluene ND 5.00 pg/L 1 1/13/2008 Ethylbenzene ND 5.00 pg/L 1 1/13/2008 m,p-Xylene ND 5.00 pg/L 1 1/13/2008 ! o Xylene ND 5.00 pg/L 1 1/13/2008 r Naphthalene ND 20.0 pg/L 1 1/13/2008 Adjusted C5-C8 Aliphatic ND . 75.0 pg/L 1 1/13/2008 Hydrocarbons Adjusted C9-C12 Aliphatic 149 75.0 pg/L 1 1/13/2008 Hydrocarbons Surr:2,5-Dibromotoluene FID 106 70-130 %REC 1 1/13/2008 Surr:2,5-Dibromotoluene PID 77.7 70-130 %REC 1 1/13/2008 i i i j 1 i I 4 i 1 1 I 1 I S i i / I i i Qualifiers: B Analyte detected in the associated Method Blank BRL_ Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit S Spike Recovery outside recovery limits Page 7 of 11 i i s I i p GeoLalbs, Inc. Reported Date: 14-Jan-09 I I CLIENT: ENSR Client Sample ID: MW-9 ¢ i Lab Order: 0901079 Collection Date: 1/8/2009 1:40:00 PM Project: CFI 2142,02140251 Date Received: 1/9/2009 Lab ID: 0901079-009 Matrix: GROUNDWATER t Analyses Result Det.Limit Qual Units DF Date Analyzed VPH-MADEP VPH Analyst: kd C9-C10 Aromatic Hydrocarbons ND 75.0 pg/L 1 1/13/2008 i Unadjusted C5-C8 Aliphatic ND 75.0 pg/L 1 1/13/2008 ? Hydrocarbons f Unadjusted C9-C12 Aliphatic ND 75.0 pg/L 1 1/13/2008 s Hydrocarbons i Methyl Tert-Butyl Ether ND 5.00 pg/L 1 1/13/2008 j Benzene ND 5.00 pg/L 1 1/13/2008 Toluene ND 5.00 pg/L 1 1/13/2008 Ethylbenzene ND 5.00 pg/L 1 1/13/2008 m,p-Xylene ND 5.00 pg/L 1 1/13/2008 o-Xylene. ND 5.00 pg/L 1 1/13/2008 Naphthalene ND 20.0 pg/L 1 1/13/2008 Adjusted C5-C8 Aliphatic ND 75.0 pg/L 1 1/13/2008 f Hydrocarbons Adjusted C9-C12 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons Surr:2,5-Dibromotoluene FID 96.0 70-130 %REC 1 1/13/2008 Surr:2,5-Dibromotoluene PID 78.3 70-130 %REC 1 1/13/2008 i i i I i E i4f f i c !rI l Qualifiers: B Analyte detected in the associated Method Blank BRL Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit S Spike Recovery outside recovery limits I Page 9 of 11 i i f I I GeoLabs, Inc. Reported Date: 14-Jan-09 CLIENT: ENSR Client Sample ID: DUP , Lab Order: 0901079 Collection Date: 1/8/2009 2:20:00 PM Project: CFI 2142,02140251 Date Received: 1/9/2009 Lab ID: 0901079-010 Matrix: GROUNDWATER Analyses Result Det.Limit Qual Units DF Date Analyzed VPH-MADEP VPH Analyst:.kd C9-C10 Aromatic Hydrocarbons ND 75.0 pg/L 1 1/13/2068 z Unadjusted C5-C8 Aliphatic ND 75.0 pg/L 1 1/13/2008 [ Hydrocarbons !f Unadjusted C9-C12 Aliphatic 146 75.0 pg/L 1 1/13/2008 Hydrocarbons Methyl Tert-Butyl Ether ND 5.00 pg/L 1 1/13/2008 f� Benzene ND 5:00 pg/L 1 1/13/2008 Toluene ND 5.00 pg/L 1 1/13/2008 Ethylbenzene ND 5.00 pg/L 1 1/13/2008 m,p-Xylene ND 5.00 pg/L 1 1/13/2008 o Xylene ND 5.00 pg/L 1 1/13/2008 Naphthalene ND 20.0 pg/L 1 1/13/2008 Adjusted C5-C8 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons Adjusted C9-Cl2 Aliphatic 146 75.0 pg/L 1 1/13/2008 Hydrocarbons Surr:2,5-Dibromotoluene FID 96.8 70-130 %REC 1 1/13/2008 Surr:2,5-Dibromotoluene PID 77.6 70-130 %REC 1 1/13/2008 i i i r E i i I i r i i . I I i i i i Qualifiers: B Analyte detected in the associated Method Blank BRL Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit S Spike Recovery outside recovery limits Page 10 of 11 4 I f piI • i i. f GeoLabs, Inc. Reported Date: 14-Jan-09 J CLIENT: ENSR Client Sample ID: Trip Blank Lab Order: 0901079 . Collection Date: Project: CFI 2142,02140251 Date Received: 1/9/2009 6 P. Lab ID: 0901079-011 Matrix: OTHER e Analyses Result Det.Limit Qual Units DF Date Analyzed VPH-MADEP VPH Analyst: kd i C9-Cl0 Aromatic Hydrocarbons ND 75.0 pg/L 1 1/13/2008 Unadjusted C5-C8 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons I Unadjusted C9-C12 Aliphatic ND 75.0 pg/L 1 1/13/2008 I Hydrocarbons I Methyl Tert-Butyl Ether ND 5.00 pg/L 1 1/13/2008 j Benzene ND 5.00 pg/L 1 1/13/2008 Toluene ND 5.00 pg/L 1 1/13/2008 Ethylbenzene ND 5.00 pg/L 1 1/13/2008 m,p-Xylene ND 5.00 pg/L 1 1/13/2008 o-Xylene ND 5.00 pg/L 1 1/13/2008 Naphthalene ND 20.0 pg/L 1 1/13/2008 Adjusted C5-C8 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons Adjusted C9-Cl2 Aliphatic ND 75.0 pg/L 1 1/13/2008 Hydrocarbons Surr.2,5-Dibromotoluene FID 119 70-130 %REC 1 1/13/2008 i Surr:2,5-Dibromotoluene PID 102 70-130 %REC 1 1/13/2008 1 I I I i I i r f I I I i i i I i1 I III Qualifiers: B Analyte detected in the associated Method Blank BRL Below Reporting Limit f E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quanthation limits ND Not Detected at the Reporting Limit S Spike Recovery outside recovery limits i Page 11 of 11 'i I GeoLabs, Inc. Date: 14-Jan-09 CLIENT: ENSR Work Order: 0901079 ANALYTICAL QC SUMMARY REPORT Project: CFI 2142,02140251 TestCode: VPH W2 Sample ID: MBLK SampType: MBLK TestCode:VPH_W2 Units: pg/L Pre Date: p RunNo: 28149 Client ID: ZZZZZ Batch ID: R28149 TestNo:VPH Analysis Date: 1/13/2008 SegNo: 296192 Analyte Result PQL SPK value SPK Ref Val %REC Lowl-imit HighLimit RPD Ref Val %RPD RPDLimit Qual 1,2,4-Trimethylbenzene ND 5.00 2,2,4-Trimethylbenzene ND 5.00 2-Methylpentane ND 5.00 n-Butylcyclohexane ND 5.00 n-Decane ND 5.00 n-Nonane ND 5.00 n-Pentane ND 5.00 C9-C10 Aromatic Hydrocarbons ND 75.0 Unadjusted C5-C8 Aliphatic Hydrocarbo ND 75.0 Unadjusted C9-C12 Aliphatic Hydrocarb ND 75.0 Methyl Tert-Butyl Ether ND 5.00 Benzene ND 5.00 Toluene ND 5.00 Ethylbenzene ND 5.00 m,p-Xylene ND 5.00 o-Xylene ND 5.00 Naphthalene ND 20.0 Adjusted C5-C8 Aliphatic Hydrocarbons ND 75.0 Adjusted C9-C12 Aliphatic Hydrocarbon ND 75.0 Surr:2,5-Dibromotoluene FID 110.9 0 100 0 111 70 130 Surr:2,5-Dibromotoluene PID 80.22 0. 100 l) 80.2 70 130 Sample ID: LCS SampType: LCS TestCode:VPH_W2 Units: pg/L Prep Date: Client ID: ZZZZZ Batch ID: R28149 TestNo:VPH Analysis Date: 1/13/2008 RunNo: 28149 SegNo: 296190 Analyte Result PQL SPK value SPK Ref Val %REC Lowbmit HighLimit RPD Ref Val %RPD RPDLimit Qual 1,2,4-Trimethylbenzene 96.28 5.00 100 0 96.3 70 13 0 0 2,2,4-Tnmethylbenzene 90.98 5.00 100 0 91.0 70. 130 2-Methylpentane 92.14 5.00 100 0 92.1 70 130 Qualifiers: BRL Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit R RPD outside recovery limits S Spike Recovery outside recovery limits Page I of 3 CLIENT: ENSR ANALYTICAL QC SUMMARY REPORT Work Order: 0901079 Project: CFI 2142,02140251 TestCode: VPH W2 Sample ID: LCS SampType: LCS TestCode:VPH_W2 Units: pg/L Prep Date: RunNo: 28149 Client ID: ZZZZZ Batch ID: R28149 TestNo:VPH Analysis Date: 111312008 SegNo: 296190 Analyte Result PQL SPK value SPK Ref Val %REC Lowl-imit HighLimit RPD Ref Val %RPD RPDLimit Qual n-Butylcyclohexane 72.67 5.00 100 0 72.7 70 130 n-Decane 83.36 5.00 100 0 83.4 70 130 n-Nonane 46.26 5.00 100 0 46.3 30 130 n-Pentane 95.32 5.00 100 0 95.3 70 130 C9-C10 Aromatic Hydrocarbons 77.02 75.0 100 3.481 73.5 70 130 Unadjusted C5-C8 Aliphatic Hydrocarbo 603.6 75.0 600 37.59 94.3 70 130 Unadjusted C9-C12 Aliphatic Hydrocarb 538.0 75.0 .600 15.05 87.2 70 130 Methyl Tert-Butyl Ether 88.37 5.00 100 0 88.4 70 130 Benzene 93.84 5.00 100 0 93.8 70 130 Toluene 94.28 5.00 100 0 04.3 70 130 Ethylbenzene 96.78 5.00. 100 0 96.8 70 130 m,p-Xylene 190.3 5.00 200 0 95.1 70 130 o-Xylene 95.25. 5.00 100 0 95.3 70 130 Naphthalene 124.5 20.0 100 0 125, 70 130 Surr.2,5-Dibromotoluene FID 104.3 0 100 0 104 70 130 Surr:2,5-Dibromotoluene PID 109.3 0 100 0 109 70 130 Sample ID: LCSD SampType: LCSD TestCode:VPH_W2 Units: yg/L Prep Date: RunNo: 28149 Client ID: ZZZZZ Batch ID: R28149 TestNo: VPH Analysis Date: 111312008 SegNo: 296191 Analyte Result PQL SPK value SPK Ref Val %REC Lowl-imit HighLimit. RPD Ref Val* %RPD RPDLimit Qua[ 1,2,4-Trimethylbenzene 96.39 5.00 100 0 96.4 70 130 96.28 0.113 25 2,2,4-Trimethylbenzene 90.40 5.00 100 0 90.4 70 130 90.98 0.644 25 2-Methylpentane 94.40 5.00 100 0 94.4 70 130 92.14 .2.42 25 n-Butylcyclohexane 77.04 5.00 100 0 77.0 70 130. 72.67 5.84 25 n-Decane 83.26 5.00 100 0 83.3 70 130 83.36 0.124 25 n-Nonane 45.64 5.00 100 0 45.6 30 130 46.26 1.36 25 n-Pentane 98.04 5.00 100 0 98.0 70 130 95.32 2.81 25 C9-Cl0 Aromatic Hydrocarbons 96.23 75.0 100 3.481 92.8 70 130 77.02 22.2 25 Unadjusted C5-C8 Aliphatic Hydrocarbo 588.2 75.0 600 37.59 91.8 70 130 603.6 2.58 25 Qualifiers: BRL Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits. ND Not Detected at the Reporting Limit R RPD outside recovery limits S Spike Recovery outside recovery limits Page 2 Of 3 , CLIENT: ENSR WorkOrder: 0901079 ANALYTICAL QC SUMMARY REPORT Work Project: CFI 2142,02140251 TestCode: VPH W2 Sample ID: LCSD SampType: LCSD TestCode:VPH_W2 Units: pg/L Prep Date: RunNo: 28149 Client ID: 77777 Batch ID: R28149 TestNo:VPH Analysis Date: 1/13/2008 SegNo: 296191 Analyte Result PQL SPK value SPK Ref Val %REC Lowl-imit Highl-imit RPD Ref Val %RPD RPDLimit Qual Unadjusted C9-C12 Aliphatic Hydrocarb 547.3 75.0 600 15.05 88.7 70 130 538 1.73 25 Methyl Tert-Butyl Ether 87.62 5.00 100 0 87.6 70 130 88.37 0.849 25 Benzene 94.87 5.00 100 0 94.9 70 130 93.84 1.09 25 Toluene 94.35 5.00 100 0 94.3 70 130 94.28. 0.0700 25 Ethylbenzene 95.71 5.00 100 0 .95.' . 70 130 96.78 1.10 25 m,p-Xylene 192.1 5.00 200 0 96.0 70 130 190.3 0.944 25 o-Xylene 95.09 5.00 100 0 95.1 70 130 95.25. 0.172 25 Naphthalene 121.5 20.0 100 0 121 70 130 124.5 .2.48 25 Surr:2,5-Dibromotoluene FID 83.93 0 100 0 83.9 70 130 0 0 25 Surr:2,5-Dibromotoluene PID 82.08 0 100 0 82.1 70 130 0 0 25 Qualifiers: BRL Below Reporting Limit E Value above quantitation range H Holding times for preparation or analysis exceeded J Analyte detected below quantitation limits ND Not Detected at the Reporting Limit R RPD outside recovery limits S Spike Recovery outside recovery limits Page 3 Of 3 t Page of GCHAIN H Nn wiCjm�STODY RECORD Filtration Sample Handling: circle choice � � , S� Special Instructions G.Labs,Inc. 45 Johnson Lane;Braintree, MA 02184 Not Needed 3g��Done ��,I- AX p 781.848.7844 • f 781.848.7811 Lab to do T l www.geolabs.com I Preservation Labtodo Y/N 'coiled.,,- dcAe ebone2d pe, r3 Nn bQ iJZ3 Turnaround:circle one Data Delivery:circle choice(s) Requirements:circle choice(s) 0'3 0 10 7 9 Fax GW-1 MCP Methods CT RCP(Reasonable Confidence Protocols) 1-day 3-day Format: S-1 DEP State/Fed Program-Criteria 2-day 5/7-days Excel PDF OC Other Client: e-Ca/— Phone: re 311 iy ly 3`747f�' 02-f qd Project: Address: j4--e &° 6C'ZCk /I- Fax: Project PO: Contact: �rf � ����r� ^r email: �f�^P c�' S ���o/`�-G�/� Invoice to Preserative: COLLECTION CONTAINER Analysis Requested s 0 M W L 0 T A T A C G A A I M SAMPLE Y A T 0 R a g T P B N GeoLabs SAMPLE NUMBER E M L y LOCATION/ID P I R M A a E E E T 1 P B W p 0 Y X �� H 13 s'Q fi(erx t ro G o0 7 [ d CIO� q \b Matrix Codes: Received on Ice Preservatives Containers: GW=Ground Water DW=Drinking Water S=Soil A=Air 1 =Hd 3=H2SO4 5=NaOH 7=Other A=Amber B=Bag 0=Other G=Glass P=Plastic WW=Waste Water SL=Sludge 0=Oil OT=Other 2=HNO3 4=Na2S203 6=MEOH S=Summa V=Voa Relinquished by: Date/Time Received by: J Date/Time 280720.J&P.0 of CR.10/07/08 Terms:Paym6nt due within 30 days unless other arrangements are made.Past due balances subject to interest and collection cost. CT(PH-0148) MA(MA-015) NH(2508) NJ(MA-009) Note:Homeowners and Law Finns must pay when dropping off samples.We accept cash,check and credit cards. NY(11796) PA(68-03417) RI(LA000252) Page of ' ., instructions CHAIN ®F C6�ST®®Y REC®RD Sam le Handling: circ � ( ' Special GeoLabs, Inc. Environmental Laboratories Filtration Done I ,- 5r (r�.�`b^' t ? GeoLabs,Inc. 45 Johnson Lane, Braintree, MA 02184 Not Needed ' + p 781.848.7844 e f 781.848.7811 Lab to do www.geolabs.com Preservation Lab to do Y/N Data Delivery:circle choices -°nts:circle choice(s) Turnaround:circle one ry O Pequiremc.. - Fax email GW-1 MCP Methods CT RCP(Reason"Able Confidence Protocols) 1-day 3-day - ., . Format: S-1 DEP State/Fed Program-Cnteria . ........._ .. 2-day 5/7-days Excel PDF OC Other Client: C"N Phone:.. err A Address: �' Q—n�id �PiT 3 = Project: �� f� ,�,� Fax: / Project PO: Contact: ��1 ALL ire r i"r`i email: A l \r, ale��� /Ut C:� 4e Invoice to*: Preserative: COLLECTION CONTAINER Analysis Requested D T A 0 M W L T I P B A A Y SAMPLE T 0 R ¢ B H E E L y LOCATION/ID P I R M A GeoLabs SAMPLE NUMBER E E T I P B D Y X � F H Matrix Codes: Received on Ice Preservatives Containers: GW=Ground Water DW=Drinking Water S=Soil A=Air 1 =Hcl 3=H2SO4 5=NaOH 7=Other A=Amber B=Bag 0=Other WW=Waste Water SL=Sludge 0=Oil OT=Other 2 HNO3 4=Na2S203 6=MEOH G=Glass P=PlasticS=Summa V=Voa Relinquished by: Date/Time Received by: Date/Time ;3o 280720.J .0 f CR.10/07/08 Terms:P ment a wit n 30 days unless other arrangements are made.Past due balances subject to interest and collection cost. CT(PH-0148) MA(MA-015) NH(2508) NJ(MA-009) Note:Homeowners and Law Firms must pay when dropping off samples.we accept cash,check and credit cards. NY(11796) PA(68-03417) RI(LA000252) ENSR AECOM ENSR 95 State Road,Sagamore Beach, Massachusetts,02562-2415 T 508.888.3900 F 508.888.6689 www.ensr.aecom.com July 24, 2007 ENSR File: 02140-251 Town of Barnstable € `= Board of Health t, 367 Main Street Hyannis, MA 02090 RE: Laboratory Analytical Results Cumberland Farms, Inc. Facility#2142 r- 395 West Main Street Hyannis, Massachusetts Release Tracking Number 4-14257 To Whom It May Concern: This letter is intended to satisfy the public involvement requirements outlined in the Massachusetts Contingency Plan (MCP) 310 CMR 40.1400. ENSR Corporation (ENSR) is providing environmental consulting services to our client, Cumberland Farms, Inc. (CFI)at the above-referenced facility with respect to Release Tracking Number(RTN)4-14257 assigned by the Massachusetts Department of Environmental Protection (DEP). On July 12, 2007, ENSR collected groundwater samples from monitoring wells situated in the town right of way on Soumi Road. Pursuant to the MCP 310 CMR 40.1403(10)(b), please find enclosed a copy of the laboratory analytical report. In addition, ENSR has written this letter to inform you of the proposed field schedule related to collection of environmental samples from your property pursuant to 310 CMR 40.1403(10)(b). This work is currently under the same sample schedule as established previously; however, per current regulations we are now required to provide a written communication for your records. This work will involve the collection of groundwater samples from monitoring wells on your property on a quarterly basis, with exact dates dependent on weather conditions. Pursuant to 310 CMR 40.1403(10)(a), ENSR will provide sample results from the quarterly sampling events within 15 days of the date the sample results are issued by the laboratory. In addition, pursuant to the MCP 310 CMR 40.1403(10)(b), this letter is intended to inform you that public involvement opportunities are available under the MCP 310 CMR 40.1403(9)and 310 CMR 40.1404. If you have any questions, please contact Christopher Johnson of CFI at(800) 225-9702 extension 3415 or the undersigned. Sincerely yours, Brian D. Serrecchia David L. Espy Project Manager CFI Program Manager cc: Christopher Johnson -CFI JA0052\Projects\P20(2000-2999)\2140 Cumberland Farms\MA\Hyannis-251(W. Main)\Corr\Public Notification\Notification letters\July 2007\Town of Barnstable Public Notification-251.doc e A I t, NOTICE OF ENVIRONMENTAL SAMPLING As required by 310 CMR 40.1403(10) of the Massachusetts Contingency Plan BWSC 123 This Notice is Related to Release Tracking Number 47 14257 A. The address of the disposal site related to this Notice and Release Tracking Number(provided above): 1. Street Address: 395 West Main Street City/Town: Hyannis Zip Code: 02601 B. This notice is being provided to the following party: 1. Name: Town of Barnstable 2. Street Address: 367 Main Street City/Town: Hyannis Zip Code: 02601 C. This notice is being given to inform its recipient(the party listed in Section B): ❑✓ 1. That environmental sampling will be/has been conducted at property owned by the recipient of this notice. Z2. Of the results of environmental sampling conducted at property owned by the recipient of this notice. ❑✓ 3. Check to indicate if the analytical results are attached. (If item 2. above is checked, the analytical results from the environmental sampling must be attached to this notice.). D. Location of the property where the environmental sampling will be/has been conducted: 1. Street Address: Suomi Road City/Town: Hyannis Zip Code: 02601 2. MCP phase of work during which the sampling will be/has been conducted: ❑ Immediate Response Action ❑ Phase III Feasibility Evaluation ❑Release Abatement Measure ❑ Phase IV Remedy Implementation Plan ❑Utility-related Abatement Measure ❑✓ Phase V/Remedy Operation Status ❑Phase I Initial Site Investigation ❑ Post-Class C Operation, Maintenance and Monitoring ❑Phase II Comprehensive Site Assessment ❑ Other (specify) 3. Description of property where sampling will be/has been conducted: ❑residential ❑commerical ❑industrial ❑school/playground ❑✓ Other right of way (specify) 4. Description of the sampling locations and types(e.g., soil, groundwater)to the extent known at the time of this notice. Groundwater samples were collected from monitoring wells situated in the right of way of Suomi Road. E. Contact information related to the party providing this notice: Contact Name: Christopher Johnson Street Address: 777 Dedham Street City/Town: Canton Zip Code: 02021 Telephone: (800)225-9702 Email: cjohnson@cumberlandfarms.com NOTICE OF ENVIRONMENTAL SAMPLING As required by 310 CMR 40.1403(10) of the Massachusetts Contingency Plan MASSACHUSETTS REGULATIONS THAT REQUIRE THIS NOTICE This notice is being provided pursuant to the Massachusetts Contingency Plan and the notification requirement at 310 CMR 40.1403(10). The Massachusetts Contingency Plan is a state regulation that specifies requirements for parties who are taking actions to address releases of chemicals (oil or hazardous material) to the environment. THE PERSON(S) PROVIDING THIS NOTICE This notice has been sent to you by the party who is addressing a release of oil or hazardous material to the environment at the location listed in Section A on the reverse side of this form. (The regulations refer to the area where the oil or hazardous material is present as the "disposal site".) PURPOSE OF THIS NOTICE When environmental samples are taken as part of an investigation under the Massachusetts Contingency Plan at a property on behalf of someone other than the owner of the property, the regulations require that the property owner (listed in Section B on the reverse side of this form) be given notice of the environmental sampling. The regulations also require that the property owner subsequently receive the analytical results following the analysis of the environmental samples. Section C on the reverse side of this form indicates the circumstance under which you are receiving this notice at this time. If you are receiving this notice to inform you of the analytical results following the analysis of the environmental samples, you should also have received, as an attachment, a copy of analytical results. These results should indicate the number and type(s) of samples (e.g., soil, groundwater) analyzed, . any chemicals identified, and the measured concentrations of those chemicals. Section D on the reverse side of this form identifies the property where the environmental sampling will be/has been conducted, provides a description of the sampling locations within the property, and indicates the phase of work under the Massachusetts Contingency Plan regulatory process during which the samples will be/were collected. FOR MORE INFORMATION Information about the general process for addressing releases of oil or hazardous material under the. Massachusetts Contingency Plan and related public involvement opportunities may be found at http://www.mass. og v/der)/cleanup/oview.htm. For more information regarding this notice, you may contact the party listed in Section E on the reverse side of this form. Information about the disposal site identified in Section A is also available in files at the Massachusetts Department of Environmental Protection. See http://mass.gov/dep/about/region/schedule.htm if you would like to make an appointment to see these files. Please reference the Release Tracking Number listed in the upper right hand corner on the reverse side of this form when making file review appointments. GROUNDWATER Groundwater Analytical, P.C .Boxx120000 ANALYTICAL 228 Main Street Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 Ewrw.groundwater inalytical,com July 20, 2007 Mr. Brian Serrecchia ENSR International 95 State Road Sagamore Beach, MA 02562 LABORATORY REPORT Project: CFI #2142/02140251 Lab ID: 108922 Received: 07-13-07 Dear Brian: Enclosed are the analytical results for the above referenced project. The project was processed for Priority turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a sample receipt report detailing the samples received, a project narrative indicating project changes and non-conformances, a quality control report, and a statement of our state certifications. The analytical results contained in this report meet all applicable NELAC standards, except as may be specifically noted, or described in the project narrative. This report may only be used or reproduced in its entirety. attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the information,the material contained in this report is, to the best of my knowledge and belief, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sincerely&Mager Eric H. Je Operatio E HJ/aj h Enclosures Page 1 of 27 GROUNDWATER ANALYTICAL Sample Receipt Report Project: CFI#2142/02140251 Delivery: GWA Courier Temperature: 4.8'C Client: ENSR International Airbill: n/a Chain of Custody: Present Lab ID: 108922 Lab Receipt: 07-13-07 Custody Seal(s): n/a Lab ID Field ID, Matrix Sampled. Method Notes , 108922-1 MW-1 Aqueous 7/12/07 14:05 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986397 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986395 40 mL VOA Vial Proline BX26640 HCL R-5235B 06-20-07 n/a C986388 40 mL VOA Vial Proline BX26640 HCL R-5235B 06-20-07 n/a LAID Field ID Matrix .: . Sampled . Method -` Notes 108922-2 MW-2 Aqueous 7112107 14:10 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986392 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986391 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986390 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab ID Field ID" Matrix i Sampled` Method Notes 108922-3 MW-3 Aqueous 7112107 14:15 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot' Prep Ship C986396 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986389 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986387 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab ID Field ID Matrix Sampled Method Notes 1089224 MW-4 Aqueous 7112107 1 4:20 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986400 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986399 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986398 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a -Lab ID Field ID" Matrix" Sampled Method Notes 108922-5 MW-5 Aqueous 7/12/07 14:30 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986382 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986372 40 mL VOA Vial Proline BX26640 HCL R-5235B 06-20-07 n/a C986371 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab ID Field ID Matrix Sampled Method Notes 108922-6 MW-51D Aqueous 7/12/07 14:35 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986370 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986369 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986353 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab ID, Field ID Matrix Sampled- Method Notes 108922-7 MW-6 Aqueous 7/12/07 14:45 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C989599 40 mL VOA Vial Proline BX26833 HCL R-52356 06-20-07 n/a C989598 40 mL VOA Vial Proline BX26833 HCL R-52356 06-20-07 n/a C986394 40 mL VOA Vial Proline SX26640 HCL R-52356 06-20-07 n/a Page 2 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 f GROUNDWATER ANALYTICAL Sample Receipt Report (Continued) Project: CFI#2142/02140251 Delivery: GWA Courier Temperature: 4.81C Client: ENSR International Airbill: n/a Chain of Custody: Present Lab ID: 108922 Lab Receipt: 07-13-07 Custody Seal(s): n/a Lab ID Field ID Matrix Sampled Method Notes 108922-8 MW-7 Aqueous 7112/07 14:50 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986402 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986401 40 mL VOA Vial Proline BX26640 HCL R-5235B 06-20-07 n/a C986363 40 mL VOA Vial Proline BX26640 HCL R-5235B 06-20-07 n/a Lab ID Field ID Matrix Sampled' Method Notes . 108922-9 MW-8 Aqueous 7112107 1 5:00 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986375 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a 686374 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986373 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab ID Field ID;'.= Matrix v v.-Sampled Method,, Notes 108922-10 MW-9 Aqueous 7112107 1 5:05 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986362 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986361 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986360 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab IDj40 Field ID Matrix Sampled Method" " Notes 1 0892 2-1 110 Aqueous 7/12/07 15:10 MA DEP VPH with Targets Con IDContainer Vendor QC Lot Presery QC Lot Prep Ship C986386mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986385mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986384mL VOA Vial Proline BX26640 HCL R-52356 06-20-07. n/a Lab ID Field ID - Matrix : Sampled Method Notes 1 0892 2-1 2 MW-11 Aqueous 7/12/07 15:15 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986368 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986367 40 mL VOA Vial Proline. BX26640 HCL R-52356 06-20-07 n/a C986366 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab ID Field ID: Matrix, Sampled Method. „ Notes 108922-13 DUP Aqueous 7/12/07 14:50 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986378 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986377 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986376 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Lab ID " Field ID -Matrix Sampled Method Notes :. 108922-14 Trip Aqueous 7112107 0:00 MA DEP VPH with Targets Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C986359 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a C986320 40 mL VOA Vial Proline BX26640 HCL R-52356 06-20-07 n/a Page 3 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 r GROUNDWATER ANALYTICAL Data Certification Project: CFI#2142/02140251 Lab ID: 108922 Client: ENSR International Received: 07-13-07 14:28 MA DEP Compendium of Analytical Methods Project Location: n/a MA DEP RTN: n/a This Form provides certifications for the following data set: MA DEP VPH: 108922-1,-2,-3,-4,5,-6,-7,8,-9,-10,-11,-12,-13,-14 Sample Matrices: Groundwater (X) Soil/Sediment ( ) Drinking Water ( ) Other ( ) MCP SW-846. 8260E ( ) 8151A ( ) 8330 ( ) 6010E ( ) 7470A/1A ( ) Methods Used 8270C ( ) 8081A ( ) VPH (X) 6020A ( ) 9012A2 ( ) As specified in MA DEP 8082 ( ) 8021 B ( ) EPH ( ) 7000 S3 ( ) Other ( ) Compendium of Analytical 1 'List Release Tracking Number(RTN),if known. Methods . 2.-SW-846 Method 9012A(Equivalent to9014)or'MA DEP Physiologically Available Cyanide(PAC)Method (check all.:that apply) 3.'S-SW-846 Methods 7000 Series..List.individual method and analyte An affirmative response to questions A,B,C and D is required for"Presumptive Certainty"status. A. Were all samples received by the laboratory in a condition consistent with that described on the Chain-of-Custody documentation for the data set? Yes B. Were all QA/QC procedures required for the specified analytical method(s) included in this report followed,including the requirement to note and discuss in a narrative QC data that did not meet appropriate performance standards or guidelines? Yes C. Does the analytical data included in this report meet all the requirements for"Presumptive Certainty,"as described in Section 2.0 of the MA DEP document CAM VII A,Quality Assurance and Quality Control Guidelines for the Acquisition and Reporting of Analytical Data? Yes D. VPH and EPH methods only: Was the VPH or EPH method run without significant modifications,as specified in Section 11.3? Yes A response to questions E and F below is required for"Presumptive Certainty"status. E. Were all QC performance standards and recommendations for the specified methods achieved? Yes F. Were results for all analyte-list compounds/elements for the specified method(s)reported? Yes All No answers are addressed in the attached Project Narrative. I,the undersigned,attest under the pains and penalties of perjury that,based upon my personal inquiry of those responsible for obtaining the information,the material contained in this analytical report is,to the best of my nowledge and belief,accurate and complete. Signature: Position: Operations Manager Printed Name: Eric H. ensen Date: 07-20-07 Page 4 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: MW-5 Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation: HCl/Cool Laboratory ID: 108922-05 QC Batch ID: VG2-3038-W Sampled: 07-12-07 14:30 Instrument ID: GC-2 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-17-07 04:19 Dilution Factor: 1 Analyst: MW VPH,Ranges ' - Concentration Notes Units,-". Reporting Limit n-05 to n-C8 Aliphatic Hydrocarbons to 200 ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons t® 500 ug/L 20 n-C9 to n-C10 Aromatic Hydrocarbons t 310 ug/L 20 Unad'u ted n-05 to n-C8 Aliphatic Hydrocarbons t 200 ug/L 20 Unadjusted n-C9 to n-C12 Aliphatic Hydrocarbons t 1,100 ug/L 20 CAS Number Analyte Concentration Notes Units, Reporting Limit a 1634-04-4 Methyl tert-but I Ether° BRL ug/L 5 71-43-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 10041-4 Eth (benzene$ 31 ug/L 5 108-38-3 and 10642-3 meta-X lene and para-X lene# 160 ug/L 5 95-47-6 ortho- X lene 58 ug/L 5 91-20-3 1 Naphthalene 5 ug/L 5 QC Surrogate Compound Spiked:` Measured -Recovery QC Limits 2,5-Dibromotoluene(PID) 50 55 111 % 70-130 2,5-Dibromotoluene(FID) 50 56 113 % 70-130% QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.2.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. © n-C9 to n-Cl2 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-CIO Aromatic Hydrocarbons range. tt Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. # Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. 1 Page 9 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: MW-5D Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation HCl/Cool Laboratory ID: 108922-06 QC Batch ID: VG2-3038-W Sampled: 07-12-07 14:35 Instrument ID: GC-2 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-17-07 04:59 Dilution Factor: 1 Analyst: MW VPH Ranges Concentration Notes Units`- RoortingLimit n-05 to n-C8 Ali phatic Hydrocarbons t0 BRL ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons t® BRL ug/L 20 n-C9 to n-C10 Aromatic Hydrocarbons t BRL ug/L 20 Unad'u ted n-05 to n-C8 Aliphatic Hydrocarbons t BRL ug/L 20 Un d us ed n-C9 to n-C12 Aliphatic Hydrocarbons t BRL ug/L 20 CAS Number Analyte Concentration Notes Units.,% Reporting Limit 1634-044 Methyl tert-but I Ether° BRL ug/L 5 71-43-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 100414 Eth (benzene# BRL ug/L 5 108-38-3 and 10642-3 meta-X lene and para-X lene$ BRL ug/L 5 95-47-6 ortho- X lene t BRL ug/L 5 91-20-3 Naphthalene BRL ug/L 5 QC Surrogate.Compound." _Spiked Measured Recovery QC Limits 2,5-Dibromotoluene(PID) 50 50 101 % 70-130 2,5-Dibromotoluene(FID) 50 51 102 % 70-130% QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.2.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. © n-C9 to n-C12 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-C10 Aromatic Hydrocarbons range. u Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. # Analyte elutes in the n-C9 to n-Cl2 Aliphatic Hydrocarbons range. Page 10 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL , Massachusetts DEP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: MW-6 Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation: HCl/Cool Laboratory ID: 108922-07 QC Batch ID: VG3-4429-W Sampled: 07-12-07 14:45 Instrument ID: GC-3 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-16-07 14:52 Dilution Factor: 1 Analyst: MW VPH Ranges Concentration Notes " Units` RepoIrtingGmit n-05 to n-C8 Aliphatic Hydrocarbons t0 67 ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons t® BRL ug/L 20 n-C9 to n-C10 Aromatic Hydrocarbons t BRL ug/L 20 Unad usted n-05 to n-C8 Aliphatic Hydrocarbons t 67 ug/L 20 Unad usted n-C9 to n-C12 Aliphatic Hydrocarbons 31 ug/L 20 CAS Number Analyte' Concentration Notes, Units. Reporting Limit: 1634-044 Methyl tert-but I Ether' BRL ug/L 5 71-43-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 10041-4 Eth (benzene# BRL ug/L 5 108-38-3 and 10"2-3 meta-X lene and para-X lene# BRL I ug/L 5 9547-6 1 ortho- X lene s BRL ug/L 5 91-20-3 Naphthalene BRL ug/L 5 QC Surrogate Compound Spiked.-Measured Recovery, QC Limits 2,5-Dibromotoluene(PID) 50 50 100 % 70-130% 2,5-Dibromotoluene(FID) 50 49 99 % 70-130% QA/QC`Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.2.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. © n-C9 to n-C12 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-C10 Aromatic Hydrocarbons range. tt Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. # Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. Page 11 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts D EP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: MW-7 Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation: HCl/Cool Laboratory ID: 108922-0.8 QC Batch ID: VG3-4429-W Sampled: 07-12-07 14:50 Instrument ID: GC-3 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-16-07 15:33 Dilution Factor: 5 Analyst: MW VPH Ranges Concentration Notes Units Reporting Limit n-05 to n-C8 Aliphatic Hydrocarbons to 710 ug/L 100 n-C9 to n-C12 Aliphatic Hydrocarbons t® 2,000 ug/L 100 n-C9 to n-C10 Aromatic Hydrocarbons t 5,000 ug/L 100 Unadjusted n-05 to n-C8 Aliphatic Hydrocarbons t 720 ug/L 100 Unadjusted n-C9 to n-C12 Aliphatic H drocarbons t 8,000 ug/L 100 CAS Number Analyte' Concentration Notes Units` Reporting;Limit 1634-044 Methyl tert-butyl Ether° BRL ug/L 25 7143-2 Benzene° BRL ug/L 5 108-88-3 Toluene° BRL ug/L 25 100414 Eth (benzene t BRL ug/L 25 toaasa an 110642-3 meta-X lene and para-X lene# 580 ug/L 25 95 47-6 ortho- X lene# 410 ug/L 25 91-20-3 Naphthalene BRL ug/L 25 QC Surrogate Compound Spiked , Measured Recovery QC Limits 2,5-Dibromotoluene(PID) 50 53 107 °% 70-130% 2,5-Dibromotoluene(FID) 50 56 113 % 70-130 QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.2.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered.part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. © n-C9 to n-C12 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-C10 Aromatic Hydrocarbons range. tt Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. t Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. Page 12 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: MW-9 Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation: HCl/Cool Laboratory ID: 108922-10 QC Batch ID: VG3-4429-W Sampled: 07-12-07 15:05 Instrument ID: GC-3 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-16-07 16:53 Dilution Factor: 1 Analyst: MW VPH Ranges Concentration Notes Units Reporting Limit n-05 to n-C8 Aliphatic Hydrocarbons to BRL ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons to BRL ug/L 20 n-C9 to n-C10 Aromatic Hydrocarbons t BRL ug/L 20 Unadjusted n-05 to n-C8 Aliphatic Hydrocarbons t BRL ug/L 20 Unad'us ed n-C9 to n-C12 Aliphatic Hydrocarbons t BRL ug/L 20 CAS Number Analyte Concentration Notes Units Reporting Limit 1634-044 Methyl tert-but I Ether° BRL ug/L 5 7143-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 100-414 Eth (benzene$ BRL ug/L 5 108-38-3and 10642-3 1 meta-X lene and para-X lenetI BRL ug/L 5 9547-6 ortho- X lene BRL ug/L 5 91-20-3 Naphthalene BRL ug/L 5 QC Surrogate Compound Spiked' . Measured Recovery QC Limits 2,5-Dibromotoluene(PID) 50 47 94 % 70-130% 2,5-Dibromotoluene(FID) 50 48 95 % 70-130% QA/QC Certification: 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.12.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. © n-C9 to n-C12 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-CIO Aromatic Hydrocarbons range. 1x Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. t Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. Page 14 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: MW-10 Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation: HCl/Cool Laboratory ID: 108922-11 QC Batch ID: VG3-4429-W Sampled: 07-12-07 15:10 Instrument ID: GC-3 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-16-07 17:33 Dilution Factor: 1 Analyst: MW VPH Ranges Concentration Notes ' Units deporting Limit n-05 to n-C8-Aliphatic Hydrocarbons t0 BRL ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons to, BRL ug/L 20 n-C9 to n-C10 Aromatic Hydrocarbons t BRL ug/L 20 Unad u t d n-05 to n-C8 Aliphatic Hydrocarbons t BRL ug/L 20 Unad u ted n-C9 to n-C12 Aliphatic Hydrocarbons t BRL ug/L 20 CAS Number: <Analyte;,. Concentration Notes Units Reporting Limit 1634-044 Methyl tert-butyl Ether° BRL ug/L 5 71-43-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 100414 Eth (benzene# BRL ug/L 5 108-38-3 and 106-12-3 meta-X lene and para-X lene BRL ug/L 5 95-47-6 ortho- X lene° BRL ug/L 5 91-20-3 Naphthalene BRL ug/L 5 QC Surrogate Compound ` Spiked Measured Recovery -• QC Limits 2,5-Dibromotoluene(PID) 50 47 93 % 70-130% 2,5-Dibromotoluene(FID) 50 45 90 % 70-130% QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QAIQC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.2.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic(Hydrocarbons range data excludes the method target analyte concentrations. 0 n-C9 to n-C12 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-C10 Aromatic Hydrocarbons range. n Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. t Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. Page 15 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: DUP Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation: HCl/Cool Laboratory ID: 108922-13 QC Batch ID: VG34429-W Sampled: 07-12-07 14:50 Instrument ID: GC-3 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-16-07 18:54 Dilution Factor: 5 Analyst: MW VPH Ranges Concentration°` Notes Units' ReportingLimrt n-05 to n-C8 Aliphatic Hydrocarbons t0 670 ug/L 100 n-C9 to n-C12 Aliphatic Hydrocarbons t® 2,000 ug/L 100 n-C9 to n-Cl0 Aromatic Hydrocarbons t 5,100 ug/L 100 Unadjusted n-05 to n-C8 Aliphatic H drocarbons t 680 ug/L 100 Unadjusted n-C9 to n-C12 Aliphatic Hydrocarbons t 8,100 ug/L 100 CAS Number Analyte;;. Concentration Notes Units'- Reportlo8 iimlt.' 1634-044 Methyl tert-butyl Ether° BRL ug/L 25 7143-2 Benzene° BRL ug/L 5 108-88-3 Toluene° BRL ug/L 25 10041-4 Eth (benzene# BRL ug/L 25 108-38-3 and 10&42-3 meta-X lene and para-X lene# 600 ug/L 25 9547-6 ortho- X lene# 430 ug/L 25 91-20-3 Naphthalene BRL ug/L 25 QC Surrogate Compound Spiked Measured Recovery„. QC Limits 2,5-Dibromotoluene(PID) 50 55 110 % M-130% 2,5-Dibromotoluene(FID) 50 56 113 % 70-130% QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.2.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-CS to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. © n-C9 to n-C12 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-C10 Aromatic Hydrocarbons range. n Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. # Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. I f Page 17 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Massachusetts DEP VPH Method Volatile Petroleum Hydrocarbons by GC/PID/FID Field ID: Trip Matrix: Aqueous Project: CFI#2142/2140251 Container: 40 mL VOA Vial Client: ENSR International Preservation: HCl/Cool Laboratory ID: 108922-14 QC Batch ID: VG3-4429-W Sampled: 07-12-07 00:00 Instrument ID: GC-3 HP 5890 Received: 07-13-07 14:28 Sample Volume: 5 mL Analyzed: 07-16-07 19:35 Dilution Factor: 1 Analyst: MW VPH Ranges Concentration, Notes Units Reporting Limit n-05 to n-C8 Aliphatic Hydrocarbons to BRL ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons t® BRL ug/L 20 n-C9 to n-CI0 Aromatic Hydrocarbons t BRL ug/L 20 Unad u ted n-05 to n-C8 Aliphatic H drocarbons t BRL ug/L 20 Unad'u ed n-C9 to n-C12 Aliphatic Hydrocarbons t BRL ug/L 20 CAS Number ' Analyte _ Concentration Notes Units ReportingLimit 1634-044 Methyl tert-butyl Ether° BRL ug/L 5 7143-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 10041-4 Eth (benzene t BRL ug/L 5 108-38-3 and 10642-3 meta-X lene and para-X lene t � BRL ug/L 5 9547-6 ortho- X lene: BRL ug/L 5 91-20-3 Naphthalene BRL ug/L 5 QC Surrogate Compound Spiked :Measured Recovery., QC Limits 2,5-Dibromotoluene(PID) 50 51 102 % 70-130% 2,5-Dibromotoluene(FID) 50 51 101 % 70-130% QA/QC Certification 1. Were all QA/QC procedures required by the method followed? Yes 2. Were all performance/acceptance standards for the required QA/QC procedures achieved? Yes 3. Were any significant modifications made to the method,as specified in Section 11.3.2.1? No Method non-conformances indicated above are detailed below on this data report,or in the accompanying project narrative and project quality control report. Release of this data is authorized by the accompanying signed project cover letter. The accompanying cover letter,project narrative and quality control report are considered part of this data report. Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. ® n-C9 to.n-Cl2 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-C10 Aromatic Hydrocarbons range. tt. Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. t Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. Page 18 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Project Narrative Project: CFI#2142/02140251 Lab ID: 108922 Client: ENSR International Received: 07-13-07 14:28 A. Documentation and Client Communication The following documentation discrepancies,and client changes or amendments were noted for this project: 1 . No documentation discrepancies,changes,or amendments were noted. B.Method Modifications;Non-Conformances and Observations The sample(s) in this project were analyzed by the references analytical method(s),and no method modifications, non-conformances or analytical issues were noted,except as indicated below: 1 . MA DEP VPH Note: Samples 108922-08 and-13.Sample were diluted prior to analysis. Dilution was required to keep all target analytes within calibration. Page 19 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 PEE .�, a x 2a8 Ma. Sircet 4:£lost L�t70 /�.u�R R� � GROMMMER $ti ,N°" 2. `rd7fk'I�'SQ�+! S#OD �i r r e., s} g �a,•FAX tie} s� r6 . ,. 4 eranOw ��csm;' a, 1�± �._ �. .., `�. IRN �., �.� � i. �t UEST xr s• '. : u ,r r , Pest9lertnPt;Bs' M ,aa„ „Va tiles pti°" t�.. 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' ..�,.. < e};Ea�apiRr =.,rj d: „ Q_, pucattrrileet on ard.Trg3 Cik?nks. r 'spaelfie;C2C-t' e afle scud , z "fir t�eCe Pi:Tem er <a � .... 4 :.< �, ;. s5:�, e.C7uptieat@s P $... CCT,,. 'CaS ti. fi WS.Forrt. latriuS 'a ••<. _ <. x> . .,., 404040, IrddRYa fix Ae.[}u I e3's I ::.. ...._ . .:.`_... <. ..:...> .. >.' ... .•ems-._ ,Sq 77, ' ..,= AnayzeDu¢hcatesAodTnpsS}�ats>aniy:rE esElts MGP< 4Y w2• A 3; firprr�t:spec�Rc3l!r1e r"Fwed`�>. �. �L'!:t a, A ,9 «je+t sPRefC�Ct4G te:i,uro ch r ':.x., �, , Y -' ., Gam' le tz Fmch WAND A -:.'NY S'E`ddRSs :<,:. .,•,«. . ,:,.x to" P Yi E F„ .<,, ,,, ;._ nd Sem'.. �e ::.° r.. - :•'.: C�Rtasr3ar Coons, � , pie Duplicate 9tes an sdd "ai'satn le adi x;. F > .I`j.Nti,'. OI.k�ra P Oam.CerbRcat�.r ;eared. =r I (P' .S C., x:� ,,.::, -. < a,,. ? -" -.,.mot s e'at,ProjeC#.; cH7c• C,.., ui Ae� Pshad by E)a <:'i5ine Reeei$uct.9z LtaboFaf07V:' �FPP�nylRdrtit� a'•` <-- -, ,:. e,:a Rl. 'I�,if�aste[pisplzsa€ is� _ ., e ---,'- t°-IDttte t Ct+�stet Ll EsEP..tebs AAaai` Fetlecal En a <• -:'.: N ', .' ,' ', � :� .; .,>._ Marrtx p.,k9!)Fgr}3�rx1®,' - P Gusiady'Sasl ':.. UPS o' " GROUNDWATER ANALYTICAL Quality Assurance/Quality Control A. Program Overview Groundwater Analytical conducts an active Quality Assurance program to ensure the production of high quality, valid data. This program closely follows the guidance provided by Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans, US EPA QAMS-005/80. (1980), and Test Methods for Evaluating Solid Waste, US EPA, SW-846, Update III (1996). Quality Control protocols include written Standard Operating Procedures (SOPs) developed for each analytical method. SOPS are derived from US EPA methodologies and other established references. Standards are prepared from commercially obtained reference materials of certified purity, and documented for traceability. Quality Assessment protocols for most organic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. All samples, standards, blanks, laboratory control samples, matrix spikes and sample duplicates are spiked with internal standards and surrogate compounds. All instrument sequences begin with an initial calibration verification standard and a blank; and excepting GC/MS sequences, all sequences close with a continuing calibration standard. GC/MS systems are tuned to appropriate ion abundance criteria daily, or for each 12 hour operating period, whichever is more frequent. Quality Assessment protocols for most inorganic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. Standard curves are derived from one reagent blank and four concentration levels. Curve validity is verified by standard recoveries within plus or minus ten percent of the curve. B. Definitions! Batches are used as the basic unit for Quality Assessment. A Batch is defined as twenty or fewer samples of the same matrix which are prepared together for the same analysis, using the same lots of reagents and the same techniques or manipulations, all within the same continuum of time, up to but not exceeding 24 hours. Laboratory Control Samples are used to assess the accuracy of the analytical method. A Laboratory Control Sample consists of reagent water or sodium sulfate spiked with a group of target analytes representative of the method analytes. Accuracy is defined as the degree of agreement of the measured value with the true or expected value. Percent Recoveries for the Laboratory Control Samples are calculated to assess accuracy. Method Blanks are used to assess the level of contamination present in the analytical system. Method Blanks consist of reagent water or an aliquot of sodium sulfate. Method Blanks are taken through all the appropriate steps of an analytical method. Sample data reported is not corrected for blank contamination. Surrogate Compounds are used to assess the effectiveness of an analytical method in dealing with each sample matrix. Surrogate Compounds are organic compounds which are similar to the target analytes of interest in chemical behavior, but which are not normally found in environmental samples. Percent Recoveries are calculated for each Surrogate Compound.. Page 22 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Samples LCS LCSD Category: MA DEP VPH Instrument ID: GC-2 HP 5890 Instrument ID: GC-2 HP 5890 QC Batch ID: VG2-3038-W Analyzed: 07-16-07 09:19 Analyzed: 07-16-07 10:18 Matrix: Aqueous Analyst: MW Analyst: MW Units: ug/L CAS Number Analyte LCS. LCS Duplicate., QC Limitsr Spiked:Measured, Recovery'," Spiked measured'`Recovery' RPD Spike RPD: 109-66-0 n-Pentane 50 50 101 % 50 46 91 % 10 % 70-130%° 25% 107-83-5 2-Methylpentane 50 55 110 % 50 52 103 % 6 % 70-130% 25% 540-84-1 2,2,4-Trim ethyl pentane 50 39 78 % 50 38 75 % 4 % 70-130% 25% n/a Aliphatic Group 1 150 140 93 % 150 140 93 % 0 °/ 70-130% 25% 111-84-2 n-Nonane 50 44 88 % 50 44 89 % 0 % 70-130% 25% 124-18-5 n-Decane 50 42 85 % 50 41 83 % 3 % 70-130% 25% 1678-93-9 n-Butylcyclohexane 50 44 88 % 50 44 89 % 0 % 70-130% 25% n/a Aliphatic Group 2 150 130 87 % 150 130 87 % 0 % 70-130% 25% 1634-044 Methyl tert-butyl Ether 50 59 117 % 50 59 117 % 0 % 70-130% 25% 71-43-2 Benzene 50 .48 97 % 50 49 99 % 2 % 70-130% 25% 108-88-3 Toluene 50 49 98 % 50 50 100 % 1 % 70-130% 25% 100414 1 Ethylbenzene 50 48 95 % 50 48 96 % 1 % 70-130% 25% 108-38-3 and 10642-3 meta-Xylene and para-Xylene 100 98 98 % 100 99 99 % 1 % 70-130% 25% 9547-6 ortho- Xylene 50 44 88 % 50 45 89 % 2 % 70-130% 25% 95-63-6 1,2,4-Trim ethyl ben zene 50 49 98 % 50 50 101 % 2 % 70-130% 25% 91-20-3 Naphthalene 50 52 104 % 50 54 107 % 3 % 70-130% 25% n/a Aromatic Group 450 450 100 % 450 450 100 % 0 % 70-130% 25% QC Surrogate Compound Spiked measured Recovery Spiked measured Recovery. QC Limits 2,5-Dibromotoluene(PID) 50 52 104 % 50 48 97 % 70-130% 2,5-Dibromotoluene(FID) 50 53 106 % 50 49 99 % 70-130% Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. Page 23 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: MA DEP VPH Instrument ID: GC-2 HP 5890 QC Batch ID: VG2-3038-W Analyzed: 07-16-07 12:27 Matrix: Aqueous Analyst: MW VPH Ranges. . Concentration Notes : Units Reporting limit , . n-05 to n-C8 Aliphatic Hydrocarbons t0 BRL ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons t® BRL ug/L 20 n-C9 to n-Cl0 Aromatic Hydrocarbons t BRL ug/L 20 nad usted n-05 to n-C8 Aliphatic H drocarbons t BRL ug/L 20 Unad usted n-C9 to n-C12 Aliphatic H drocarbons t BRL ug/L 20 CAS Number Analyte..,:. Concentration Notes Units Reporting Limit 1634-044 Methyl tert-but I Ether° BRL ug/L 5 7143-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 100414 Eth (benzene# BRL ug/L 5 108-38-3 and 10642-3 meta-X lene and para-X lene: BRL ug/L 5 9547-6 ortho- X lene t BRL ug/L 5 91-20-3 Naphthalene BRL ug/L 5 QC-Surrogate Compound.. . SpikedC�Measured `Recovery; QC Limits 2,5-Dibromotoluene(PID) 50 54 109 % 70-130 2,5-Dibromotoluene(Flo) 50 56 112 % 70-130 Method Reference: Method for the Determination of Volatile Pet"oleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes corcentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. ® n-C9 to n-C12 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-C i 0 Aromatic Hydrocarbons range. M Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. # Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. 1 `+ Page 24 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 6 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Samples LCS LCSID Category: MA DEP VPH Instrument ID: GC-3 HP 5890 Instrument ID: GC-3 HP 5890 QC Batch ID: VG3-4429-W Analyzed: 07-16-07 10:40 Analyzed: 07-16-07 11:20 Matrix: Aqueous Analyst: MW Analyst: MW Units: ug/L CAS Number Analyte. - LCS LCS C)uplicefe QC Limits: Spiked;ea and Recovery'`Spiked Measured Recovery RPD' Spike" RPD 109-66-0 n-Pentane 50 54 109 % 50 51 102 % 6 % 70-130% 25% 107-83-5 2-Methylpentane 50 55 110 % 50 52 103 % 6 % 70-130% 25% 540-84-1 2,2,4-Trimethylpentane 50 50 100 % 50 48 95 °% 5 % 70-130% 25% n/a Aliphatic Group 1 150 160 107 % 150 150 100 % 6 °% 70-130% 25 111 84-2 n-Nonane 50 48 97 % 50 46 92 % 5 % 70-130% 25% 124-18-5 n-Decane 50 46 91 % 50 43 86 % 6 % 70-130% 25°% 1678-93-9 n-Butylcyclohexane 50 47 94 % 50 45 89 % 5 % 70-130% 25% n/a Aliphatic Group 2 150 140 93 % 150 130 87 % 7 % 70-130% 25% 1634-044 Methyl tert-butyl Ether 50 49 97 % 50 49 97 % 0 % 70-130% 25% 71-43-2 Benzene 1 50 48 97 °% 50 47 93 % 3 °% 70-130% 25% 108-88-3 Toluene 50 48 96 % 50 46 92 % 4 % 70-130% 25% 100414 Ethylbenzene 50 48 96 % 50 46 93 °% 3 % 70-130% 25% 108-3B-3 and 106-42-3 meta-Xylene and para-Xylene 100 97 97 % 100 93 93 % 4 % 70-130% 25% 95 47-6 ortho- Xylene 50 47 93 % 50 45 90 % 3 % 70-130% 25%95-63-6 1,2,4-Trimethylbenzene 50 48 97 % 50 47 94 % 3 % 70-130% 25% 91-20-3 Naphthalene 50 45 89 % 50 44 88 % 1 % 70-130% 25% n/a Aromatic Group 450 430 96 % 450 420 93 °% 2 % QC Surrogate Compound Spiked Measured RecoverySpiked Measures Recover: P y QC Limits 2,5-Dibromotoluene(PID) 50 50 99 % 50 48 96 % 70-130 2,5-Dibromotoluene(FID) 50 50 101 % 50 48 95 °% 70-130% Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology, or alternatively based upon the historical average recovery plus or minus three standard deviation units. Page 25 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER ANALYTICAL Quality Control Report Method.Blank Category: MA DEP VPH Instrument ID: GC-3 HP 5890 QC Batch ID: VG34429-W Analyzed: 07-16-07 12:26 Matrix: Aqueous Analyst: MW VPH Ranges, - Z Concentration Notes:. Units RePorttngLimit n-05 to n-C8 Aliphatic Hydrocarbons to BRL ug/L 20 n-C9 to n-C12 Aliphatic Hydrocarbons to BRL ug/L 20 n-C9 to n-Cl0 Aromatic Hydrocarbons t BRL ug/L 20 Un d sted n-05 to n-C8 Aliphatic H drocarbons t BRL ug/L 20 Unad'usted n-C9 to n-C12 Aliphatic Hydrocarbons t BRL ug/L 20 CAS Number Analyte Concentration Notes Units Reporting Limit. 1634-04-4 Methyl tert-bu I Ether° BRL ug/L 5 7143-2 Benzene° BRL ug/L 1 108-88-3 Toluene° BRL ug/L 5 10041-4 Eth (benzene= BRL ug/L 5 10838-3 wd 10642-3 meta-X lene and para-X lene t BRL ug/L 5 9547-6 ortho- X lene t BRL ug/L 5 91-20-3 Naphthalene BRL ug/L 5 QC Surrogate Compound Spiked._;,Measured;.' Recovery, QC Limits 2,5-Dibromotoluene(PID) 50 48 95 % 70-130% 2,5-Dibromotoluene(FID) 50 49 97 % 70-130 Method Reference: Method for the Determination of Volatile Petroleum Hydrocarbons,MA DEP(Revision 1.1,2004). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. t Hydrocarbon range data excludes concentrations of any surrogate(s)and/or internal standards eluting in that range. 0 n-05 to n-C8 Aliphatic Hydrocarbons range data excludes the method target analyte concentrations. ® n-C9 to n-C12 Aliphatic Hydrocarbon range data excludes the method target analyte concentrations and the concentration for the n-C9 to n-CIO Aromatic Hydrocarbons range. to Analyte elutes in the n-05 to n-C8 Aliphatic Hydrocarbons range. # Analyte elutes in the n-C9 to n-C12 Aliphatic Hydrocarbons range. Page 26 of 27 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 r GROUNDWATER ANALYTICAL Certifications and Approvals Groundwater Analytical maintains environmental laboratory certification in a variety of states. Copies.of our current certificates may be obtained from our website: httl2://www.groundwateranalytical.com/qualifications.htm _CONNECTICUT Department of Health Services,PH-0586 Potable Water,Wastewater,Solid Waste and Soil http://www.dph.state.ct.us/BRS/Environmental_Lab/out—State.pdf FLORIDA Department of Health,Bureau of Laboratories,E87643 SDWA,CWA,RCRA/CERCLA http://www.floridadep.org/labs/qa/dohforms.htm MAINE Department of Health and Human Services, MA0103 Drinking Water and Wastewater http://www.ma i ne.gov/dhhs/eng/water/Templates/LabCertificati on/LabCertificati on.htm Department of Environmental Protection,LB-0072 Asbestos Analytical Laboratory(Bulk) MASSACH USETTS Department of Environmental Protection, M-MA-103 Potable Water and Non-Potable Water http://public.dep.state.ma.us/labcert/labcert.aspx Department of Labor, Asbestos Analytical Services,Class A Division of Occupational Safety, AA000195 http://www.mass.gov/dos/forins/la-rpt_(ist aa.pdf NEW HAMPSHIRE Department of Environmental Services, 2027 Drinking Water and Wastewater http://www.des.state.nh.us/asp/NHELAP/labsview.asp NIST NATIONAL VOLUNTARY LABORATORY ACCREDITATION PROGRAM(NVLAP) NVLAP Lab Code 200751-1 Bulk Asbestos Fiber Analysis(PLM) http://ts.nist.gov/Standards/scopes/plmtt-n.htm NEW YORK Department of Health, 1.1754 Potable Water,Non-Potable Water and Solid Waste http://www.wadsworth.org/labcertlelap/coi-nm.html RHODE ISLAND Department of Health, Potable and Non-Potable Water Microbiology,Organic and Inorganic Chemistry Division of Laboratories, LA000054 http://www.health.ri.gov/labs/outofstatelabs.pdf Department of Health, Asbestos Analytical Service,Polarized Light Microscopy(PLM) Office of Occupational and Radiological Health,AAL-110B3 http://www.health.ri.gov/envi ron ment/occupationa1/asbestos/I i censees/AsbestosAna lytical Labs.pdf U.S.DEPARTMENT OF AGRICULTURE USDA,Soil Permit, S-53921 Foreign soil import permit VERMONT Department of Health,VT87643 Drinking Water Microbiological,Inorganic and Organic Analyses http://healthvermont.gov/enviro/ph lab/documents/certified_labs.pdf Page 27 of 27 Groundwater.Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 I Town of Barnstable v0 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Susan G.Rask,R.S. Sumner Kaufman,MSPH Wayne Miller,M.D. Mr. Robert Pellegrini, Jr. December 30, 2003 Law Department Cumberland Farms 777 Dedham Street Canton, MA 02021-9118 RE: Fuel Tanks at 395 West Main Street, Hyannis A= 8 9 i:?Gli-i16 Dear Mr. Pellegrini, You are granted a conditional variance on behalf of your client, Cumberland Farms, to maintain the existing underground fuel storage tanks, at 395 West Main Street, Hyannis Massachusetts. The Board voted unanimously not to require you to replace the four underground tanks with the following condition: • Underground tank testing results, for each of the four tanks, shall be submitted to the Board of Health annually, before December 31st each year. Although the tanks are more than 20 years of age at this time, you testified that all of the tanks are constructed of fiberglass with interstitial monitoring systems (Veeder-Root TLS 350). Cumberland Farms staff conducts daily monitoring of the tanks and monthly reconciliation. You also stated that the piping was recently upgraded to state-of-the-art flexible piping. Please ensure that you mail the test results to our Board of Health mailing addre s which is : 200 Main Street, Hyannis, MA 02601. Sin e ely yo "",4k�_ Wayn Miller, M.D. Chair an CumberlandPellegrini I e°vee CumbeAnd Farms® 777 DEDHAM STREET,CANTON,MASSACHUSETTS 02021-9118 PHONE:781-828-4900 WEBSITE: WWW.CUMBERLANDFARMS.COM LAW DEPARTMENT X�2`�� RECEIVED October 24, 2003 OCT 2 7 2003 VIA.OVERNIGHT MAIL TOWHEALTH RNSTABLE Thomas A. McKean, RS, CHO Health Agent Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 RE: Underground Storage Tanks at 395 West Main Street Tank Numbers 1, 2, 3, and 4 Dear Mr.,McKean: I am today in receipt of your letters dated October 17, 2003. I was unable to contact you in your office this afternoon. Please be advised that Cumberland Farms formerly petitions the Board for a hearing regarding this matter. While Cumberland Farms fully intends to comply with your mandate, Cumberland Farms would like an extension until Spring, so that the Company may diligently pursue permits and then construct during a time of the year when freezing will not be a factor during the construction phase. This brief delay should not present any environmental risks, as Cumberland Farms has performed a piping upgrade recently, installing state-of-the-art flexible piping. In addition, all of the existing tanks are fiberglass. Furthermore, Cumberland Farms conducts daily and monthly inventory reconciliation(manual and computerized). The Company has also invested in an in- tank monitoring system(Veeder-Root TLS 350), which considers gasoline pumped while constantly monitoring internal fuel levels. In the meantime, Cumberland Farms is willing to T perform a complete tank system test to verify its integrity. Please direct all future correspondence to me. Thank you for your consideration. r ely 1 " Robert R. Pellegrim, Jr. Attorney for Cumberland Farms CC: Francis Sheflin,Director of Planning Richard Etzold,Manager of the UST program BRANDED PRODUCTS GUlf Massachu Department of Conservation and Recre s Office of Water Resources 148411 TYPE OR PRINT ONLY Well Completion Report , F LOCATION GPS (Required). North �° a West ? Wit°- ' at Well Location: ^K At � _..._ __ Property Owner/Client:� �t l t �arl F_ �%Son Name _ Mailing Address-ity/Town Ciry/Town: �1 Y�.... 1 0 i Assessors Map-.',' Assessors Lot#: NOTE: Assessors Map and_Lot#,mandatory-J no t eet add ess available Board of Health permit obtained:_ Yes i] Not.Required: Permit Number Date.lssued r 2 WORK PERFORMED 3'A WELL TYPE " 4.=DRILLING_'METHOD - 6.CASING, =' Overburden Bedrock _ From (ft) To (ft) �• Type�f,.¢Thickness -Diameter Al 5.WELL LOG OVERBURDEN 1 Extra Water Loss or Drop m ❑❑� LITHOLOGY Bearing Addition , Drill Fast orL �❑Slow From (ft) To(ft) -Code, Color Comment Zone of Fluid Stem Drily Rate T' SCREEN Q 2i F CS Y / N Y / N F/ S From(ft)''To`{ft) " Type Slot Size Diameter Y / N Y / N F / S Y / N Y / N F / S ❑❑❑ Y / N Y / N F / S g.ANNULAR SEAL/FILTER PACK/ABANDONMENT.MTL. Y / N Y / N F /;S From{ft) To (ft) Material Description : Purpose Y / N Y / N F /'S `'"I �� 7 [N Y / N Y / N F�,IS- ❑❑ - ❑_❑ Y / N Y / N, 'F,% Sv El El El Y / N ' Y N-1 ❑❑� ❑❑ WELL,LOG 'BEDROCK Extra 4 s: �9.SITE SKETCH Water- Drop in Extra. Visible Loss or #of LITHOLOGY Bearing Drill Large Fast or, "Rust Addition Fracture Slow. From (ft) To(ft) Code Comment Zone Stem Ctiips.grill Rate Staining of Fluid per foot Y / N e Y'J�N-F�/ S Y / N Y /. N Y / N,Y %"N F / S Y / N Y / N LA X/ NY``/-N F / S Y / N Y / N ty-j'NY / N F / S Y / NYIN 9� _a(�hNII] fN F / S Y / N Y / N ` Y,ON Y / N F / S Y / N Y / N Y-4NY / N F / S Y / N Y / N Y / N Y / N F / S Y / N Y / N Z� Y / NY / N F / S ,Y / N Y / N � r" Y / NY / NF / SY / NY / N _ -- 10.WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 11. STATIG ATER LEVEL tALL WELLS) Yield Time Pumped Pumping Level- Time to Recover Recovery Depth Below Date Method (GPM) n tris&min) (Ft. BGS) (hrs 8 min). (Ft.BGS) Date MeaSL red Wrounit$urface (ft) 12. PERMANENT PUMP PF AVAILABLE) 1.3.ADDITIONAL WELL INFORMATION Pump Description. `❑'❑ 1-1Horsepower Developed Y / Fracture Enhancement Y /4 Pump Intake Depth (ft) Nominal Pump Capacity (gpm) Disinfected Y Surface-Seal Type ❑a 14.COMMENTS � � _ �p{ va Qk a� o� YV� Total Well Depth "z1 Depth to Bedrock 15.WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandoned under my supervision, according to applicable er rules and regulations, and this re, rt is complete and correct to the best of my knowledge. Driller: ` Su ervisin Driller Si nature: ❑ �nA( . r -Re istration #:I 111 �I y I t. 9 g ! 9 (� Firm: f ��� �1 IiI L Date Com fete.", _ / ` C� Rig Permit#: I I I�'I 1 I NOTE: Well Completion Reports must he filed by the registered.well driller within 30.days of well completion. - BOARD OF HEALTH COPY t` , r, • Well Completion Report Cow Section 2 ` Section 3 Section 4 Work - Well Drilling. Work Performed Type Method Performed Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection =CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofracture. HF " Geoconstruction GCON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE . Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW { Monitoring -, MONT 'j !' Dug DG , Public Water Supply PBWS Mud Rotary MR' Recovery RCVR - Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 Section 6 t Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code). Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 b. Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL t Brown C BR Conglomerate/Breccia. CG/BR Galvanized Pipe GLP Schedule 40 Coarse Sand - CS } Dark Gray , DG `Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 , Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 Fine to Coarse Sand FCS Reddish Brown RB Granite GR Stainless Steel SST SDR 17 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 I Organics 0 Quartzite QZ SDR 32.5 Sand&Gravel *SG - Rhyolite RH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty.Sand&Gravel SISG Slate/Phyllite SL/PH Till T ► Pegmatite PM Section 7 Section 8 Section 10 Annular SeallFilter Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type Code'- _ Pack/Abandonment Material Code Purpose Code Method Code Carbon.Steel CST Bentonite Chips/Pellets BC Fill FL , Air Blow with Drill Stem AB Continuous Wire PVC CWP + Bentonite Grout BG Filter FT Air Lift AL Galvanized Wire Wrapped GWW _ Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP _ Concrete CT Constant Rate Pump CR Pre-pack PVC PPP Sand SD Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLP Stainless Steel Vee Wire SSV Stainless Steel Well Point SSP Section 12 Section 13 Pump r Description Well Seal Pump Description Code Horsepower Surface Seal Type Type Code 2 Wire Constant Speed Submersible 2WSS 1/2 20 Cement CM 3 Wire Constant Speed Submersible 3WSS 3/4 25 Cement/Bentonite CB " Constant Speed Submersible Turbine CSST 1 30 Concrete CT Variable Speed Submersible Turbine VSST 1 1/2 40 None NO Jet JET 2 50 Line Shaft Turbine LST•-• 3 • 60 - Centrifical CENT 5 75 7 1/2 100 s V .t< V03 + .. : ,ry _ , r s- a 10 as125,�,: :: .i..'a_c t ,. ., `� ,t,•r., a=x =. s.s s► . 15 150- ; 200= �- Massachus s Department of Conservation and.Re cre Office of Water Resources148413 -TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATNON GPS (Required) North'5 _L0 -1- JL- West --'L -a' 14 T5_ c 355 1J T n IST ,Address at Well Location Property Owner/Client: t((k a �1 t Subdivision Name i~ Mailing Address: t6 Si ._. i :: .C.' Trown C1t-tl1�Y��i1S +�`.`�,4 _ 4 t rtY City/Town" OZ4Z� _ Assessors Map = Assessors Lot#: NOTE: Assessors Map and Lot#mandatory-if no street address-available Board.of;Health permit obtained: Yes ElNot Required 00 Permit Number Dateassued" 2,WORK PERFORMED 3:WEL6.TYPE. 4.DRILLING METHOD 6.CASING [�I-Rrl, Overburden Bedrock From(ft) _To.(ft) Type Thickness Diameter[YvlN FAI.. OG ❑ Q ,- �'C 0 stkl 40 z K 5. WELL LOGOVERBURDEN ``` i Extra Water Loss=or Drop in �," LITHOLOGY Bearing Addition- Drill Fast-or ❑❑1-1 Zone of Fluid 'Stem Slow 7, SCREEN From(ft) To (ft) Code Color Comment Drill Rate From ft rToQ tt ` Type Slot Size Diameter. C) - ,� GCS 1K , Y,/ N Y,/ N . F.,/ S. " ' ,ER®❑L 010 2 � Y / N Y / N F / $ El El 1:1 El El El Y7'N Y / N F / S ;' 8:ANNULAR SEAL/FILTER PACK/ABANDONMENT MTL Y / N • Y / N F'/�S From`(ft) To (ft) Material Description Purpose Y / N Y / N F / g t ❑❑ ❑❑ Y / N Y / N f= /,5 '- El El, ❑❑ Y / N Y / Nd F-/,,$ - ❑❑ ❑ ❑ Y / N Y It,N ❑❑ ❑ WELL-,L: G, BEDROCK Extra ' �.': 9. SITE SKETCH = Water .Drop in Extra UisiFile, Loss.or #of Fast orl . LITHOLOGY Bearing . Drill Large Rust Addition Fractur From(ft) To (ft). Code Comment Zone Stem Chips<t)SI Rate Staining of Fluid per foot L Y / NY'/`N. F�/ S Y / N Y / N 0 Y / fiIY,/°N F / S Y / N Y / N V? 3 5 Y,/ NYC/-N' F / SY / NY / N ( tryY, 'N,Y / N F / S Y / N Y / N si y Yl-,NY / N F / S Y / N Y / N Y,_PNY / N F / S Y / N Y / N Yam"% NY / N F / S Y / N Y / N Y / NY / NF / SY_/ NY / N n � a Y / NY / NF / SYl,IVY / N -- � <� P Y / NY / N F / S Y / N Y / N 10. WELL TEST DATA(ALL SECTIONS MANDATORY FOR.PRODUCTION WELLS) 11.STATIC WATER-LEVEL(ALL WELLS) Yield Time°Pumped Pumping Level Time to Recover Recovery Depth Below 4 , Date Method (GPM) (hrs.&min)` (R. BGS) (his&min) (R. BGS) Date Measured Ground Surface(ft) ( II I1000 12. PERMANENT, PUMP(IF AVAILABLE) 13._ADDITIONAL WELLJNFORMATNON Fump.Description ` ,❑ ❑r❑ Horsepower Developed Y /.Q)Fracture.Enhancement Y:/ 1' Pump Intake Depth - - (ft) Nominal Pump Capacity =,(gpm) Disinfect Y / .0 Surface'Seal-Type 44. COMMENTS r spmc 20A. . W Total Well Depth Depth to Bedrock 15.WELL DRILLER'S STATEMENT This well was drilldd, altered, and/or abandoned under my supervision, according to applicable ,�[4" rules and regulations; and this re ort is comet I to and correct to the best of my knowledge. Driller:t � _ Supervising Driller Si nature:�i'n�� ��. loos, Registration #:� I !1 C� P 9 9 _ 9 Firm: t VV rl � _ Date Co nplete: l?- 14-n tom, Rig Permit#: � NOTE:-Well Completion Reports must be filed by the registefed well_driller within 30 days of well completion. BOARD OF HEAdH COPY Well Completion Report C IN io i Section 2 Section 3 Section 4 Work Well Drilling Work Performed Type Method Performed Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofracture HF Geoconstruction GCON Auger AG New Well NW Geothermal Closed Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA , Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR Test Wells •TSTW Sonic SN r Section 5 Section 6 Overburden Casing Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code Thickness . (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP -Schedule 40 Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 Fine to Coarse Sand FCS Reddish Brown RB Granite GR Stainless Steel SST SDR 17 s Gravel • G Yellowish'Brown YB Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA - SDR 26 i Organics 0 Quartzite QZ SDR 32.5 a Sand&Gravel SG Rhyolite RH SDR 40 Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel SISG Slate/Phyllite SL/PH Till T 'Pegmatite PM t Section 7 Section 8 Se ction 10 Annular Seal/Filter Screen ' Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type Code PacklAbandonment Material Code Purpose Code Method Code Carbon Steel CST Bentonite Chips/Pellets . BC Fill FL Air Blow with Drill Stem AB Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lift AL Galvanized`Wire'Wrapped GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete CT Constant Rate Pump CR Pre-pack PVC PPP Sand SD Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLP Stainless Steel Vee Wire SSV Stainless Steel Well Point SSP q. , Section 12 Section 13 Pump j Description Well Seal. Pump Description Code Horsepower Surface Seal Type Type Code 2 Wire Constant Speed Submersible 2WSS 1/2 20 Cement `CM 3 Wire Constant Speed Submersible 3WSS 3/4 25 _ Cement/Bentonite CB Constant Speed Submersible Turbine CSST 1 30 Concrete CT Variable Speed Submersible Turbine VSST. 1 1/2' 40 None NO Jet JET 2 50 Line Shaft Turbine LST - -3- 60 Centrifical CENT 5 75 i 71/2 100 _ 10 125 _ sw .."8�31�t:'.y t. $,'�"S `3.i"•, t 3; .?> 15 150� a cs. �� 200., TANKS] :! 91 FUEL STORAGE TANK RECORDS ] HELP [ ] FOR PARCEL NBR: 2691 1161 ] ] MAIN ACTION I] Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- L ] [ 11 [ 8631 [0101821 [B ] Test 0630921 Rem ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - [3] [103096] [ ] [ ] [ ] [ ] [ ] [ ] Fuel Reason Capacity Constr Status Leak-Det Cath-Det [D ] [B ] [ 80001 [FD] [N ] [Y] [ ] Additional Details [TEST #2 081895 ] -------------------------------------------------------------------------------- Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ 21 [ 8641 [0101821 [B ] Test 0630921 Rem ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - [3] [1030961 [ ] [ ] [ ] [ ] [ ] [ ] Fuel Reason Capacity Constr Status Leak-Det Cath-Det [G ] [B ] [ 80001 [FD] [N ] [Y] [ ] Additional Details [TEST #2 081895 ] -------------------------------------------------------------------------------- Cancel [ ] Press XMT for more data NEXT SCREEN [TANKS] ACTION [I] PARCEL NBR [269] [116] [ ] ] TANK NBR [ 31 TANKS] 01 FUEL STORAGE TANK RECORDS ] HELP [ ] FOR PARCEL NBR: 2691 1161 ] ] MAIN ACTION I] Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ 31 [ 8651 [0101821 [B ] Test 0630921 Rem ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - [3] [1030961 [ ] [ ] [ ] [ ] [ ] [ ] Fuel Reason Capacity Constr Status Leak-Det Cath-Det [G ] [B ] [ 80001 [FD] [N ] [Y] [ ] Additional Details [TEST #2 081895 ] -------------------------------------------------------------------------------- Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ 41 [ 8661 [0101821 [B ] Test 0630921 Rem ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - [3] [1030961 [ ] [ ] [ ] [ ] [ ] [ ] Fuel Reason Capacity Constr Status Leak-Det Cath-Det [G ] [B ] [ 80001 [FD] [N ] [Y] [ ] Additional Details [TEST #2 081895 ] -------------------------------------------------------------------------------- Cancel [ ] END OF DATA NEXT SCREEN [HMENU] ACTION [ ] PARCEL NBR [ ] [ ] [ ] l TANK NBR [ ] [ ] FEES RETAIL FOOD STORE: $75.00 FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE RESIDENTIAL KITCHEN FOR BED+BREAKFAST SEATING: 0 MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: $14.00 SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: $7.00 -4WN01= �ARNSTABLE A BOARD E H EA L14TTH PERMIT To PERATE A FOOD ES"ABLISHMENT ' PERMIT NO: 127 JANUARY 1, 1999 '` � 'A y AP A >p �� iF �� � � Y 3R- of In accordance uu h regul tij ns promuI ated under authority of Chapter 94, Section 395A ancChapter 111ISection ,o °the General Lawsla permit is hereby granted to: - CUMBERLAND FARMS 1N(� D/B/A: CUMBERLAND FARMS #23 6 `4 BIZ Whose place of business"is -39,5 WEST MiIIV $TRE "F , HYANN. S�IVIA02601 Type of business and any rest ctions RETAIL FOOD ESTABLISJ: hNT To operate a food establishment in t T&Wo B41,NSUBLE° Permit expires: December'3�19.99 �. im 50 , � - BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P. Thomas A. McKean, RS, CHO Director of Public Health Town of Barnstable x RARNS-rABLE, MASS. Board of Health �rFO MA'1 A, P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufman,MSPH Paul Canniff,D.M.D. July 12, 2006 Mr. Robert P. Coluccio Senior Engineer Web Engineering Associates, Inc. 104 Longwater Drive Norwell, MA 02061 Deart Mr Coluccio, You are granted a one year extension to remove the underground fuel storage tanks, located at 395 West Main Street, Hyannis. The extension is granted with the following conditions: 1) The manager/operator of Cumberland Farms shall perform an ATG Statistical Leak Test on a nightly basis. Cumberland Farms shall submit copies of the nightly results, along with a cover letter describing the results of the nightly tests, to the Public Health Division Office, at 200 Main Street Hyannis, Massachusetts once each month. 2) Along with the nightly tests, the manager/operator of Cumberland Farms shall submit the results of ENSR's monthly reports relative to the treatment system to the Public Health Division Office, at 200 Main Street Hyannis, Massachusetts. 3) All other quarterly, semi-annual, and annual ENSR reports shall be copied to the Public Health Division Office, at 200 Main Street Hyannis, Massachusetts, including analytical reports that demonstrate that the monitoring well adjacent to the tanks contains non-detectable levels of contamination. 4) All other equipment test and/or inspection results shall be submitted in the monthly report. 5) The manager/operator of Cumberland Farms shall notify the Public Health Division Office, at 200 Main Street Hyannis, Massachusetts immediately of any failed test results. 6) The manager/operator of Cumberland Farms shall immediately notify the Fire Department and the Public Health Division (508 862-4644)anytime an underground fuel tank alarm sounds or underground fuel tank leak indicator light"lights-up." 7) During the hearing, the Town of Barnstable Hazardous Material Specialist informed the Board members of a recent spill that occurred at the station. She stated that the on- duty operator didn't appear to know who to call. The on-duty operator was reportedly looking in the Yellow Pages for the Fire Department phone number. In response to these events, the BOH requires that Cumberland Farms post their contingency plan in a prominent location at the station. f A second hearing will be held in June 2007, at which time the Board of Health will evaluate Cumberland Farms' adherence to the extension conditions. If no issues or negative impacts associated with the station are reported, another time extension will be granted. If, in the interim, the Board of Health determines that Cumberland Farms is not adhering to the extension conditions or if any test result indicates that a leak has developed, the Board has the authority to revoke the extension at any time before the June 2007 hearing. A failed leak test, if determined to indicate an actual release, will be grounds for immediate removal of the tanks. Sincerely, Wayne Miller, M.D., Chairman BOARD OF HEALTH TOWN OF BARNSTABLE I Crocker, Sharon From: Crocker, Sharon Sent: Wednesday, April 18, 2007 12:31 PM To: McKean, Thomas Subject: Cumberland Farms-Storage Tank Replacement Attached is the BOH one-year extension letter and below are the Results from the BOH Meeting on June 13, 2006 stating we will review at the BOH meeting again at the June 2007 BOH Meeting. GRANTED Robert Coluccio, Web Engineering, representing Cumberland Farms # 2142 (a.k.a. # 2326)- 395 West Main St, WITH Hyannis, Map 269, Parcel 116, requesting appeal to maintain four (4) fiberglass 8,000 gallon underground CONDITIONS storage tanks until 2009. The owner is granted a one-year extension, until June 15, 2007, to replace the underground fuel storage tanks with the following conditions: (1) The applicant must submit monthly print-out of the daily monitoring reports (statistical leak detection reports)to the Public Health Division Office at 200 Main Street, Hyannis on a monthly basis. (2) The applicant must submit "Six-Month Remedy Operation Status Reports" once every six months to the Public Health Division Office at 200 Main Street Hyannis. (3)The operator or store manager shall immediately notify the Public Health Division and the Hyannis Fire Department if/whenever a tank alarm indicator lights or sounds. (4)The applicant is required to attend a public Board of Health meeting scheduled in one year, June 2007. LLJ CumberlandFarmse BOH Letter: xtension.doc(... 1 COMPLIANCE CHECK AFFIDAVIT I, 1�-n h 4r �k am 1-7 years old. My birthdate is MOB.., ZP , °�$� , and I reside at-A i(13 t Ln On Qj tt-j 0 1�t:�-, 2)Z ,I participated in a tobacco sales compliance check. Prior to the compliance check,I was instructed by the adult monitor to empty my pockets. I did not carry a backpack or any other bag. The only thing I carried with me was cash given to me by the adult monitor for the compliance check. The adult monitor also instructed me that I should not dress to look neither older nor dress to look younger; I dressed no different than I would dress to attend school on any typical day. Lastly, the adult monitor also instructed me to tell the truth during the compliance checks. If I was asked my age,I was to tell the truth; if asked if I was carrying identification, I was to say no. I entered l d f i2 M S 2_0,0 at 5 am/ovith s $ 5 in cash in my pocket. I attempted to purchase N\0-0 C(Q r I W(O asked for identification. I gave$ J to the clerk and received$ .90 in change. I immediately returned to the adult monitor waiting outside, informed him that the sale had been made, and gave him the tobacco I had purchased and the change from the sale. Youth Signature. i OK For 2001 Permit? Tobacco Sales Permit Inspection Report Form I TOWN OF BARNSTABLE BOARD OF HEALTH Business Name �` Date / o Business Telephone r7no - 6 2-2r7 Location 2,C, ` f Y Time: In Out Person in Charge Remarks or No tezcus Signs Posted IMGL 270/61 � v Permit Posted [Vila] 9 `%4D...R. License 6 JInt[U Employee Signed Forms AO `tom f' 4-4" Kept On File [VIIb] / t Self-service Displays ✓ On Counter and Within 5 Ft. of a Clerk [VIId] No. Floor Displays [VIId] lLr 0( A_5� grVto No Tobacco Products / � t rez '�pl yS Free of Charge [VIIc] / Otte �y�yk t a ywe • ' ��Y'Yl i vtp tSt VQ,.�t ��� SA Ifyrt 2 Get 2 �e _ q. C'Z) wi h 5� r { ` Inspector: 014 `` Person Interviewed: q:health:tobinsp S� SW►;{�er SwP� a. Town of Barnstable UE ZHE t Regulatory Services - Thomas F.Geiler,Director * snaxsrABLE. , Public Health Division Thomas McKean,Director 367 Main Street, Hyannis,MA 02601 Office: .508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM Es#ablist Survey Participants h Name: Cumberland Farms #2326 Name of Purchaser: �( or ID# Address:' 395 West Male St. Age: l`l Sex: ❑Male Female Hyannis, MA 02601 Did a second person go into the establis ent? Yes ❑ No If Yes,what was the second person's: City: Age: Sex: ❑Male ❑Female Time of Check: I "ILI am❑ pm Date of Check: 6 Z. Name of Adult Driver/Escort: AX t Type of Establishment -Check Only One ❑. Convenience Store ❑ Pharmacy/Drug Pharmacy/Drug Store Gas Mini-Mart ❑ Gas Station Only ❑ -.Groce Store ❑ 1 or Store 0 De artment Store ❑ Bar ❑ Private Club VFW,Legion etc. 0 Restaurant Bar Area ❑ Restaurant Other Area ❑ Other(bowling alley , golf club,etc.): Is this establishment within'/z mile of a school? Yes ❑ No ❑ Don't Know Is this establishment between'/2 mile and 1 mile of a school? Yes ❑ No 0 Don't Know Is this establishment between''/2 mile of a youth center(Boy's/Girl's Club)? Yes ❑ No ❑ Don't Know Is this establishment between'/2 mile and 1 mile of a youth center(Boy's/Girl's Club)? Yes ❑ No ❑ Don't Know Is this establishment within''/2 mile of an outdoor recreational site(park,ball field,etc.)? Yes ❑ No❑ Don't Know Is this establishment'between'/z..mile and 1 mile of an outdoor rec.site(park,ball field)? Yes ❑ No ❑ Don't Know Tobacco Purchase Attempt: Was the purchase of tobacco attempted: Yes, ! No ❑ If No,please explain why not: Was the sale made? Yes 0 No Brand:Purchased: Price: $ Type of Tobacco purchased attempted. Cigarettes Chew/Dip ❑ How was tobacco sold? Clerk was required to select tobacco Purchaser requested. chaser was able to place tobacc on the.counter. Was the Purchaser asked for ID? Y,e910 ❑ Was the Purchaser asked his/her age? Yes ❑No Was there any tobacco advertising(logos,posters or other promotional dis)lays?) Yes ❑ No Were any loose(single)cigarettes for sale? Yes ❑ No Don't Know Sex of Clerk: Male❑ Female "y Approximate Age of Clerk: _ Did the Clerk say anything to you when the purchase attempt was made? Mud Other Comments. How was the merchant informed of the results of the compliance check? Q By an adult supervisor immediately after youth has/have left the.premises. ❑ Notified after all compliance checks were complete. ❑ Merchant was not notified ❑ Other--:'please specify L OK For 2001 Permit? Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name�lU�y+1 2,3 2- Date T_13"U l i ��1 �cwms Business Telephone 5U - L�D— ©� 2 I Location Q `- ( i 1 Time: In Out i Person in Charge Routine Follow-up Inspector's Name Complaint Initial REGULATION: COMPLIANCE Re�tarka Yea N0 Recoumaendaticna Signs Posted [MGL 270/61 Permit Posted [VIIa] D.O.R. License Employee Signed Forms Kept On File [VIIb] ✓ Self-service Displays On Counter and Within V/ 5 Ft. of a Clerk [VIId] No. Floor Displays [VIId] �Y No Tobacco Products Free of Charge [VIIc] Inspector: Person Interviewed: q:health:tobinsp r L Town of Barnstable FfHE A Regulatory Services b O,� Thomas F.Geiler,Director ]URMA. $ Public Health Division s63q• �m prED MA'S A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM SECTION I: Establishment Survey Participants Name: Name of purchaser: j Cumberland Farms 42326 Age:_ 17 ❑ Male Female Address: 395 West Main St. Hyannis,MA 02601 Name of Adult Escort/Data Collector: City: c Time of Check: D - l ❑ AM kPM Type of Establishment: K Chain ❑ Independent ❑ Not Known Date of Check: 13 —o Z Style of Establishment(Check Only One): XConvenience Store ❑ Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store ❑ Liquor Store ❑ Department Store ❑ Bar ❑ Private Club(VFW,Legion,etc.) ❑ Restaurant(Bar Area) ❑ Restaurant(Other Area) ❑ Other(Tobacco Shop,Pro Shop, etc.) SECTION II: Did the youth enter the premises and attempt to purchase a tobacco product? Yes ❑ No If yes, continue on to the next question, if no,please skip this section and go to Section III. How was tobacco marketed? ,Over-the-counter:youth asks the clerk for the product. ❑ Over-the-counter:youth selects the product from a self-service display. ❑ From a vending machine with a lockout device. ❑ From a vending machine without a lockout device. Was the purchaser asked for ID? ❑ Yes Vo Was ID accurately checked? ❑ Yes ❑ No kN/A Was the purchaser asked his/her age? XYes ❑ No Sex of Clerk: ❑ Male X Female Approximate age of clerk: 30 +m s+y Did the Clerk say anything to you when the purchase attempt was made? S t 1 & ' �a n`+ cow 6�e� Type of tobacco asked for: Cigarettes ❑ Chew/Dip ❑ Cigars Brand ❑ Other Was the sale made? )(Yes ❑ No (if yes,how much did the product cost: $ SECTION III: If the youth did not enter the premises or did not attempt to purchase tobacco products,check here: ❑ and indicate why below: closed for the day ❑ couldn't locate business ❑ buyer knows clerk/merchant ❑ admission charge closed for the season ❑ no longer in business ❑ establishment inappropriate for youth ❑ other ❑ closed to the public ❑ doesn't sell tobacco ❑ unsafe establishment 0 unsafe area 0 denied admission at door 0 vending machine broken �._-.I``v'-...,�r. w., .r\.� ..ri,..w•_. :.._-e_....1.ate.iSs..<.,,.r.,..•,n.•..,..„a .^ M+.../La•r�s....•C?.l.T"ti•, ..r^.,... ._-. ._.-.-.. •. '^T...•. ..3,.... i, . "'•� TOWN OF BARNSTABLE ` Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 04A4m&( j&j, a-vjoS j (c Address of Offender r 3 �, u„� y, MV/MB Reg.# l~ Village/State/Zip l yle',)A r S MA �'` Z L b,1 � r Business Name �, s�r�� vs,,r am/pm�; on � fps 20°0_2-- . Business Address` . .a )7y Signature .of Enforcing .Officer Village 4 j . g p p� Location of Offense Sa-,t U- e j a. 3G"ye' t 4•�ct' Q4 Enforcing Dept/Division Offense bog P& 1-r"4 _ , .-"A + 06 15 Facts Ib1jee-411Q This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the. Town. TOWN OF BARNSTABLE BQ' - -,W MO- Ordinance or Regulation WARNING NOTICE Name of Offender/Manager s(,44J."k.i It, V to § Address of Offender MV"MB Reg.# Village/State/Zip is '1A xf Business Name 1.1'14-1, lj�r am hpml,� on i 2 0 Business Address 7.1. ra JJ, t'i" Sig-fiature of Enforcing Officer Village/State/Zip lk(411AI'r Location of Offense 15r'b"t, vo- �Xe I Enforcing Dept/Division Offense Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary ccmpliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. Town of Barnstable oF`"E A Regulatory Services Thomas F.Geiler,Director &UMSTABMAW '� Public Health Division %639. ArE p 3't° Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO COMPLIANCE CHECK FORM SECTION I: Establishment Survey Participants 41 Name: . Name of purchaser: z Cumberland Farms#2326 Age: ❑ Male Female Address: 395 West Main St. City: Hyannis,MA 02601 Name of Adult Escort/Data Collector: W Time of Check: l 'c3� ❑ AM kPM Type of Establishment: )(Chain ❑ Independent ❑ Not Known r� Date of Check: /- f-Q 2 Style of Establishment(Check Only One): Convenience Store ❑ Pharmacy/Drug Store ❑ Gas Mini-Mart ❑ Gas Station Only ❑ Grocery Store ❑ Liquor Store ❑ Department Store ❑ Bar ❑ Private Club(VFW,Legion,etc.) ❑ Restaurant(Bar Area) ❑ Restaurant(Other Area) ❑ Other(Tobacco Shop,Pro Shop, etc.) SECTION II: Did the youth enter the premises and attempt to purchase a tobacco product? Yes ❑ No If yes, continue on to the next question, if no,please skip this section and go to Section III. ko w was tobacco marketed? Over-the-counter:youth asks the clerk for the product. ❑ ver-the-counter:youth selects the product from a self-service display. ❑ From a vending machine with a lockout device. ❑ From a vending machine without a lockout device. Was the purchaser asked for ID? kYes ❑ No Was ID accurately checked? ❑ Yes ❑ No N/A Was the purchaser asked his/her age? 0 Yes XNo Sex of Clerk: ❑ Male XFemale Approximate age of clerk: ,L1101 Did the Clerk say anything to you when the purchase attempt was made? `7� glt Type of tobacco asked for: Cigarettes ❑ Chew/Dip ❑ Cigars Brand ❑ Other Was the sale made? ❑ Yes XNo (if yes,how much did the-product cost: $ ) SECTION III: If the youth did not enter the premises or did not attempt to purchase tobacco products, check here: ❑ and indicate why below: ❑ closed for the day ❑ couldn't locate business ❑ buyer knows clerk/merchant ❑ admission charge ❑ closed for the season ❑ no longer in business ❑ establishment inappropriate for youth ❑ other ❑ closed to the public ❑ doesn't sell tobacco ❑ unsafe establishment 0 unsafe area 0 denied admission at door 0 vending machine broken Massachusetts Department of En r menta BWSC-103 Bureau of Waste Site Cleanup DEC ! 6 I-Qog elease Tracking Number RELEASE NOTIFICATION & NOT C C4 FORM Pursuant to 310 CMR 40.0335 and 3 h rt C If assigned by DEP A. RELEASE OR THREAT OF RELEASE LOCATION: J Street: 395 West Plain Street Location Aid. Citynown: flvannis ZIP Code: 02601-3644 B. THIS FORM IS BEING USED TO: (check one) ® Submits Release Notification(complete all sections of this form). Submit a Retraction of a Previously Reported Notification of a Release or Threat of Release(complete Sections A.B.E,F and G of this form). You MUST attach the supporting documentation required by 310 CMR 40.0335. C. INFORMATION DESCRIBING THE RELEASE OR THREAT OF RELEASIr(TOR): Date and time you obtained knowledge of the Release or TOR. Date: _A0116198 Time: 9:00 Specify: IN AM F-I PM The date you obtained knowledge is always required. The time you obtained knowledge is not required if reporting only 120 Day Conditions. IF KNOW record date and time release or TOR occurred. Date: Time: Specify: D AM El PM ® Check here if you previously provided an Oral Notification to DEP(2 Hour and 72 Hour Reporting Conditions only). Provide date and time of Oral Notification. Date: 101 66198 Time: 1 1:45 -_ Specify: ® AM D PM Check all Notification Thresholds that apply to the Release or Threat of Release: (for more information see 310 CMR 40.0310-40.0315) 2 HOUR REPORTING CONDITIONS 72 HOUR REPORTING CONDITIONS 120 DAY REPORTING CONDITIONS Sudden Release D Subsurface Non-Aqueous Phase Release of Hazardous Material(s)to Sal or Liquid(NAPL)Equal to or Greater than Groundwater Exceeding Reportable Threat of Sudden Release 12 Inch Concentration(s) Oil Sheen on Surface Water n Underground Storage Tank(UST) Release of Oil to Sal Exceeding Reportable Release Concentration(s)and Affecting More than 2 Cubic Poses Imminent Hazard ® Yards Threat of UST Release D Could Pose Imminent Hazard Release of Oil to Groundwater Exceeding Reportable Release to Groundwater near ` Concentration(s) D Release Detected in Private Well Water Supply - DSubsurface Non-Aqueous Phase Liquid(NAPL)Release to Storm Drain D Release to Groundwater near Equal to or Greater than 1/8 Inch and Less than 112 School or Residence Inch D Sanitary Sewer Release (Imminent Hazard Only) List below the Oils or Hazardous Materials that exceed their Reportable Concentration or Reportable Quantity by the greatest amount. If necessary,attach a list of additional Oil and Hazardous Material substances subject to reporting. Name and Quantities of Oils(0)and Hazardous Materials(HM)Released: Reportable Concentrations O or HM Released 0 HM CAS A Amount or Units Exceeded,if Applicable (check one) (if known) Concentration (RCS-1,RCS-2,RCGW1,RCGW-2) Gasoline ® D — >100 wpm DD — — DD D. ADDITIONAL INVOLVED PARTIES: Check here If attaching names and addresses of owners of properties affected by the Release or Threat of Release,other than an owner who is J sutxnitttng this Release Notil'ication(required). 17 Check here if attaching Licensed Site Professional(LSP)name and address(optional). You may write in names and addresses on the bottom of the second page of this tome, Revised W1195 Supersedes Form BWSC-003 Page 1 of 2 Do Not After This Form OK For 2004 Permit? Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name / Date Business Telephone '7 7 5 957 7 Location Time: In Out Person in Initial REGIILATION COMPLIANCE Remarks or Yes No Recommendations Signs Posted [MGL 270/61 ?oa O t) Permit Posted [VIIa] � D.O.R. License Employee Signed Forms Kept On File [VIIb] / Self-service Displays On Counter and Within 5 Ft. of a Clerk [VIId] No Floor Displays [VIId] No Tobacco Products Free of Charge [VIIc] Inspector: A&Z kt iw4z Person Interviewed: q:health:tobinsp \ 6 h �D�u 641 ;Q Town of Barnsta�UAMInAIS S�- 4 Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Wayne Miller,M.D. Sumner Kaufman,MSPH Paul Canniff,D.M.D. Mr. Robert P. Coluccio July 12, 2006 Senior Engineer Web Engineering Associates, Inc. 104 Longwater Drive Norwell, MA 02061 Deart Mr Coluccio, You are granted a one year extension to remove the underground fuel storage tanks, located at 395 West Main Street, Hyannis. The extension is granted with the following conditions: 1) The manager/operator of Cumberland Farms shall perform an ATG Statistical Leak Test on a nightly basis. Cumberland Farms shall submit copies of the nightly results, along with a cover letter describing the results of the nightly tests, to the Public Health Division Office., at 200 Main Street Hyannis, Massachusetts once each month. 2) Along with the nightly tests, the manager/operator of Cumberland Farms shall submit the results of ENSR's monthly reports relative to the treatment system to the Public Health Division Office, at 200 Main Street Hyannis, Massachusetts. 3) All other quarterly, semi-annual, and annual ENSR reports shall be copied to the Public Health Division Office, at 200 Main Street Hyannis, Massachusetts, including analytical reports that demonstrate that the monitoring well adjacent to the tanks contains non-detectable levels of contamination. 4) All other equipment test and/or inspection results shall be submitted in the monthly report. 5) The manager/operator of Cumberland Farms shall notify the Public Health Division Office, at 200 Main Street Hyannis, Massachusetts immediately of any failed test results. 6) The manager/operator of Cumberland Farms shall immediately notify the Fire Department and the Public Health Division (508 862-4644) anytime an underground fuel tank alarm sounds or underground fuel tank leak indicator light"lights-up." 7) During the hearing, the Town of Barnstable Hazardous Material Specialist informed the Board members of a recent spill that occurred at the station. She stated that the on- duty operator didn't appear to know who to call. The on-duty operator was reportedly lookingin the Yellow Pages g s for the Fire phone Department p p e number. In response to these events, the BOH requires that Cumberland Farms post their contingency plan in a prominent location at the station. A second hearing will be held in June 2007, at which time the Board of Health will evaluate Cumberland Farms'adherence to the extension conditions. If no issues or negative impacts associated with the station are reported, another time extension will be granted. If, in the interim, the Board of Health determines that Cumberland Farms is not adhering to the extension conditions or if any test result indicates that a leak has developed, the Board has the authority to revoke the extension at any time before the June 2007 hearing. A failed leak test, if determined to indicate an actual release, will be grounds for immediate removal of the tanks. Sin ly, ynriller, D., Chairman B AREALTHTOWRNSTABLE 05/1j-/2066 17:07 7818281497 CUMBERLAND FARMS INC PAGE 01 777 Dedham Street Canton,MA 02021 Cumberland 781-828-4900 Farms Fax:781-828-1497 Fax - TO, Wayne Miller,M.D. Fronz Mike Durant F= 08-790-6304 ftges., phone 08-862-4644 Dotsa 1712006 Re: r Variance Extension Request fom Click here and type name] ❑Urgent ❑ For Drew . ❑Please Comment ❑Please Reply ❑Please Recycle •Comments: Dear Mr.Miller, Please find attached,a signed"Agreement to E)dend Time Limit for Ailing Upon a Variance Request" for your records. If you have any questions or require additional infomtation,please do not hesitate to contact me. CUMBERLAND FARMS INC_ Construction Department 777 Dedham Street Canton, MA 02021 Phone:781-828-4900 ext. 3310 Fax: 781-828-1497 Sincerely, Mike Durant Cumberland Farms 777 Dedham Street Canton,MA 02021 Telephone:(781)828-4900 Ext 3318 Facsimile:(781)828-1497 05/1-7/2006 17:07 78 8281497 CUMBERLAND FARMS INC PAGE 02 r_ V --- U-i r01Otbl'4y( P.1/14 IKE OTown of Bid$ nstabi? ]Board of Health G 200 Main Street - Hyannis MA 02601 t ( . BD JA Agreement to Extend Time Limit for Acting Upon a Variance Request In the Matter of a variance request form received on MoLAIQ , -the Petltioner(s), r �a r regarding the property at `� M ; �.:e the petitioner(s)and the Board of Health agree that the Board of Health has until 2Dr Zr�O (insert date)to act upon the Petitioners'completed application for a variance, In executing this Agreement,the Petitloner(s)hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Petitloner(s): Board of Health; Signature: f Signature: Petltloner(a)or PetUlonaes Reprosontaav®. Chairman Print: ,i eL ( s1) trka+ Print: Wayne Miller,M.D. Date: ,S_ l 7YG(o Date: Address of Patltloner(s)or Petitioners Representative 7 r�, De rett Board of Health 1"own of Barnstable C Uan,to � r� _o�I _ _ Public Health Division 2�7&ilA 200 Main Street Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508) 790-6304 file q:extend.dcc ray WEB ENGINEERING ASSOCIATES; 'INC.' 104 LONGWATER DRIVE NORWELL,MASSACHUSETTS 02061 781-878-7766•FAX:781-878-8004 1-800-273-7289 April 25, 2006 Thomas McKean Director of Public Health Public Health Division Town of Barnstable 200 Main Street Hyannis,MA 02601 RE: Cumberland Farms No. 2142 395 West Main Street Map Parcel No. 269116 Hyannis,MA Dear Mr. McKean: This letter is written to request a hearing before the Hyannis Board of Health for an appeal to keep four(4)underground storage tanks (USTs) in place at Cumberland Farms Station No. 2142, 395 West Main Street, Hyannis, Massachusetts (Map Parcel No. 269116). As you are aware,the subject USTs are 8,000-gallon, single-walled, fiberglass USTs used to store regular and super grades of gasoline. The tanks are located in a zone of contribution to a public supply well. The USTs currently meet all state and federal UST requirements. According to the Town of Barnstable Code No. 326: Fuel and Chemical Storage Tanks,paragraph 3(0): "underground fuel and chemical storage tanks and systems, in place on the effective date of this regulation and 20 years of age or older, located in zones of contribution to public supply wells shall be removed under the direction of the Fire Chief' The subject USTs were installed in 1982. The USTs are therefore over 20 years old and are required to be removed by town code. The USTs are currently scheduled for replacement in 2009 in accordance with Cumberland Farms standard facility upgrade protocol. At that time,the new USTs and systems will meet all applicable local, as well as state and federal,tank codes and regulations. In the interim, Cumberland Farms would like to continue use of the existing state compliant USTs until the date of the scheduled replacement. In a conversation with Lieutenant Eric Hubler of the Hyannis Fire Department on April 17, 2006, Lt. Hubler informed Web Engineering that he would concur with Cumberland Farm's plan to maintain the existing USTs in place until 2009 only if the existing USTs met all of the requirements of the Code of Massachusetts Regulations 527 CMR 9.00, "Tanks and Containers". Petroleum.Chemical Operations Engineering-Tank Management-Remediation Systems-Hazardous,Solid Waste Systems-Site Investigations-Regulatory Compliance J After reviewing the facility, Web Engineering confirms that the subject USTs and systems at Cumberland Farms Station No. 2142 in Hyannis, Massachusetts meet all of the requirements of 527 CMR 9.00. Specifically,the USTs have double-walled piping, automatic tank inventory gauging (ATG), statistical leak detection, Stage I and II vapor recovery,mechanical line leak detection, overfill protection, spill protection, and monthly inventory reconciliation. Much of these 527 CMR 9.00 compliant features were part of a 1998 facility upgrade. In addition, all USTs and systems were tested in 2005 in accordance with paragraph 326- 3(F) of the town code with passing results (see Appendix). Web Engineering has reviewed these test results, as well as inventory reconciliation records for the past 12 months, and has determined that the USTs and associated equipment are in satisfactory working order. We trust that the above information provides sufficient background information to request a hearing for an appeal before the Hyannis Board of Health to keep the existing USTs in place at the Cumberland Farms station. If you have any questions,please call. Very truly yours, Web Engineering Associates, Inc. Robert P. Coluccio Senior Engineer Cc: Lt. Eric Hubler, Hyannis Fire Department Mike Durant, Construction Supervisor, Cumberland Farms IA -1 (��*3,..y TANKNOLOGY CERTIFICATE OF TESTING ��-�n^� J 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 TELEPHONE(512)451-6334 FAX(512)459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 05/17/05 WORK ORDER NUMBER: 7158000 CUSTOMER PO: CLIENT: CUMBERLAND FARMS SITE:CUMBERLAND FARMS#2142 777 DEDHAM STREET 395 WEST MAIN STREET CANTON,MA 02021 AND SUOMI RD. HYANNIS,MA 0..2601 DEBBIE REBELLO MGR / NICK (800)225-9702 ext.3378 .(508)790-0227 TEST TYPE: TLD-1 Product Pi De Ti htness Test Results Tk ATE LINE SIN LlN Y "` ` rIIfItR CT l® PRODUCT MAT 3fATYP I RATE h s PIN syphon 1 REG UNLEAD FURON NONE y syphon 2 REG UNLEAD FURON NONE y STP 3 REG UNLEAD FURON — PRESSURE P 0.006 y 4 SUPER FURON PRESSURE P 0.006 y _. 'Existing Line Leak Detector Test EXISTING L DETECTQR1 ,EXIS7INGLEAKDE fC TOR#23 ; Ll E r ; D,,, MANUFA TURER ODEL� SER # RESU1 T M FACTHRER MODEL ' SERIALS RESULT syphon 1 syphon 2 STP 3 RED JACKET FX1V 10999-0684 P 4 RED JACKET FX2V 30698-2295 P New Replacement Line Leak Detector Test REPLACED LEA?L DETEGTQR#1 W a REP1J�tCED'IF BE�TEGTO 4 LINE( qa x c MAN FAC 1RER ' MOD1rL# SER1,4L#�- RESELL 1VAAI+I0 A" t RE M®DEL SE IAA# For owner detailed report information,visit www.tanknology.com and select On-Line Reports-WRAP,or contact your local Tanknology office. Tester Name:JOHN E.DEGUTIS Technician Certification Number:ILL 996 Printed 05/19/2005 13:07 KOHLMEYER _ 1, -i' INDIVIDUAL TANK INFORMATION AND TEST RESULTS r TankrK* gy TEST DATE: 05/17/05 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759(512)451-6334 WORK ORDER NUMBER: 7158000 CLIENT: CUMBERLAND FARMS SITE: CUMBERLAND FARMS #2142 Tank ID: syphon 1 Tank manifolded: YES Bottom to top fill in inches: 129.0 Product: REG UNLEAD Vent manifolded: YES Bottom to grade in inches: 135.0 Capacity in gallons: 7,648 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 90.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 281 Overspill-protection: YES Stage I vapor recovery: DUAL Material: FIBERGLASS Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS ATG TLS-350 TANKTESTRESUtTS es#MettiodNONEsy � �E�KDETECT012TE5,�TREStU1:�SCStmethoc# ' PSI at tank bottom: New/passed Failed/replaced New/passed Failed/replaced Fluid level in inches: L.D.#1 L.D.#1 L.D.#2 L.D.#2 LIFT/OFT: Make: Fluid volume in gallons: Model: Tank water level in inches: S/N: Test time: NOT Open time in sec: Number of themmisters: TESTED Holding psi: NOT NOT Specific gravity: Resiliency cc: TESTED TESTED Water table depth in inches: Test leak rate ml/m: Determined by(method): Metering psi: Leak rate in gph: Calib. leak in gph: Result: Results: COMMENTS COMMENTS U:L6k 4 STT�#'tESULTSTest Method NONE t INE TEST RESl1LTS Nest pe TAD.,i . w t Test time: Ullage volume: Material: FURON Ullage pressure: Diameter(in): 1.5 Results: Length(ft): 15.0 Test psi: DATA FOR UTS-4T ONLY: Bleedback cc: Time of test 1: Test time(min): Temperature: NOT Start time: NOT NOT NOT NOT Flow rate(cfh): TESTED End time: TESTED TESTED TESTED TESTED Time of test 2: Final gph: Temperature: Result: Flow rate(cfh): Pump type: NONE Time of test 3: Pump make: NONE Temperature: Flow rate(cfh): Impact Valves Operational: YES COMMENTS COMMENTS Printed 05/19/2005 13:07 KOHLMEYER A 9 ti Ij r INDIVIDUAL TANK INFORMATION AND TEST RESULTS a3 . Zip Tanlfa ck)gy TEST DATE: 05/17/05 8501 N MOPAC EXPRESSWAY,SUITE 400 'WORK ORDER NUMBER: 7158000 AUSTIN,TEXAS 78759(512)451-6334 CLIENT: CUMBERLAND FARMS SITE: CUMBERLAND FARMS #2142 Tank ID: STP 3 Tank manifolded: YES Bottom to top fill in inches: 129.o Product: REG UNLEAD Vent manifolded: YES Bottom to grade in inches: 135.0 Capacity in gallons: 7,648 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 90.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 281 Overspill protection: YES Stage I vapor recovery: DUAL Material: FIBERGLASS Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS ATG TLS-350 TANK TEST REStlL S TeSt Mefhod,N N L EA�K ETECTO^R TEST RESU1,L S cr.... TeS�ttl thOd a WN .-., _._ PSI at tank bottom: New/passed Failed/replaced New/passed Failed/replaced Fluid level in inches: L.D.#1 L.D.#1 L.D.#2 L.D.#2 UFT/OFT: Make: RED JACKET Fluid volume in gallons: Model: FXIV Tank water level in inches: S/N: 10999-0684 Test time: NOT Open time in sec: 4.00 Number of thermisters: TESTED Holding psi: 10, NOT Specific gravity: Resiliency cc: 105 TESTED Water table depth in inches: Test leak rate ml/m: 315.0 Determined by(method): Metering psi: 14 Leak rate in gph: Calib. leak in gph: 5.00 Result: Results: PASS COMMENTS COMMENTS t f LINE ST�RESULTS !P. . , ULLAGE'TESTRESl1LTS�fes 0,4t , NONE r Test e LD a. � , Test time: Ullage volume: Material: FURON FURON Ullage pressure: Diameter(in): 1.5 1.5 Results: Length(ft): 150.0 75.0 Test psi: 60 DATA FOR UTS-4T ONLY: Bleedback cc: 220 Time of test 1: Test time(min): 80 Temperature: NOT Start time: 08:10 NOT NOT NOT Flow rate(cfh): TESTED End time: 09:30 TESTED TESTED TESTED Time of test 2: Final gph: 0.006 Temperature: Result: PASS Flow rate(cfh): Pump type: PRESSURE PRESSURE Time of test 3: Pump make: RED JACKET RED JACKET Temperature: Flow rate(cfh): Impact Valves Operational: YES COMMENTS COMMENTS Printed 05/19/2005 13:07 KOHLMEYER i s.� INDIVIDUAL TANK INFORMATION AND TEST RESULTS i Tanknc* y 8501 N MOPAC EXPRESSWAY,SUITE 400 TEST DATE: 05/17/05 AUSTIN,TEXAS 78759(512)451-6334 WORK ORDER NUMBER: 7158000 CLIENT: CUMBERLAND FARMS - SITE: CUMBERLAND FARMS #2142 r W'",M �E . Tank ID: 4 Tank manifolded: No Bottom to top fill in inches: 129.0 Product: SUPER Vent manifolded: YES Bottom to grade in inches: 1. 35.0 Capacity in gallons: 7,648 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 91.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 294 Overspill protection: YES Stage I vapor recovery: DUAL Material: FIBERGLASS Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / 1 COMMENTS ATG TLS-350 TANKTEST�RESULTS� � '''� Po PSI at tank bottom:. New/passed Failed/replaced' New/passed VS Failed/replaced Fluid level in inches: L.D.#1 L.D.#1 L.D.#2 L.D.#2 LIFT/OFT: Make: RED JACKET Fluid volume in gallons: Model: Fx2v Tank water level in inches: S/N: 30698-2295 Test time: NOT Open time in sec: 2.00 Number of thermisters: TESTED Holding psi: 16 NOT Specific gravity: Resiliency cc: 75 TESTED Water table depth in inches: Test leak rate ml/m: 315.0 Determined by(method): Metering psi: 14 Leak rate in gph: Calib. leak in gph: 5.60 Result: Results: PASS COMMENTS COMMENTS INE`D 'EST R S'y T U S LLAGE�6ESTfRESULT%Tes et�od NONE Test tY e rg Test time: Ullage volume: Material: FURON FURON Ullage pressure: Diameter.(in): 1.5 1.5 Results: Length(ft): 150.0 75.0 Test psi: 6 0 DATA FOR UTS-4T ONLY: Bleedback cc: 220 Time of test 1: Test time(min): a 0 Temperature: NOT Start time: 08:10 NOT NOT NOT Flow rate(cfh): TESTED End time: 0 9:3 0 TESTED TESTED TESTED Time of test 2: Final gph: 0.006 Temperature: Result: PASS Flow rate(cfh): Pump type: PRESSURE PRESSURE Time of test 3: Pump make: RED JACKET RED JACKET Temperature: Flow rate(cfh)-. Impact.Valves Operational: YES COMMENTS COMMENTS Printed 65/19/2005 13:07 KOHLMEYER 4 CERTIFICATE OF STAGE II VAPOR RECOVERY TESTING Z P,Tanlux9ogy 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 (512)451-6334 FAX(512)459-1459 TEST DATE:05/17/05 WORK ORDER NUMBER:7158000 CLIENT: CUMBERLAND FARMS SITE: CUMBERLAND FARMS #2142 777 DEDHAM STREET 395 WEST MAIN STREET CANTON, MA 02021 AND SUOMI RD. HYANNIS, MA 02601 ATTN: DEBBIE REBELLO CONTACT: MGR / NICK 0� .PRESSUft s VRP rf, aim 1 ObUCT ,PIOTZL Sf+Et1S€ ��� r-� {RR� RESSt,f,RE)�� fi finches .fi: aura.ftpw r Yes 4 nctiesofwater at teS 3 20 40 60 80 100 Pass/ 20 40 60 80 100 Pass/~ cfh cfh cfh cfh cfh fail cfh cfh cfh cfh cfh fail GASOLINE EMCO A4005 1 - 0.08 0.14 0.20 0.30 PASS 0.06 0.14 0.20 0.32 PASS GASOLINE EMCO A4005 3 - 0.08 0.14 0.20 C.32 PASS 0.08 0.14 0.20 0.32 PASS GASOLINE EMCO A4005 5 - 0.08 0.16 0.22 0.38 PASS 0.08 0.16 0.24 0.36 PASS GASOLINE EMCO A4005 7 - 0.06 0.14 0.24 0.36 PASS 0.06 0.14 0.24 0.36 PASS GASOLINE EMCO A4005 9 - 0.08 0.14 0.20 0.32 PASS 0.06 0.12 0.20 0.32 PASS GASOLINE EMCO A4005 11 - 0.08 0.12 0.20 '0.34 PASS 0.06 0.14 0.20 0.32 PASS PRESSURE DECAY TEST �� a `� s i11[OWab��Ullcq �fi TANIf# In�tP;ress f .,, 0,11 CO S3 syphon 1 10.00 10.00 10.00 10.00 10.00 10.00 9.80 22751 PASS REPLACED 2 FILL CAPS AND 2 FILL CAP GASKETS, RAN PR DECAY 3 TIMES TO PASS. P/V VENT CAP; PR 3.2" WC. VAC 7.8" W.C. REPLACED P/V VENT ON SITE, FAILED TEST. ALSO REPLACED THREAD ON VENT j Tanknology appreciates the opportunity to serve you,and looks toward to working with you in the future.Please call any time,day or night, when you need us. Tanknology representative: Test conducted by: JOE BUICE JOHN E. DEGUTIS q y K T r,e: s Reviewed: Technician Certification Number:LL 996 Printed 05/19/2005 13:07 KOHLMEYER ��Tan►aTo/ogy 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 (512)451-6334 FAX(512)459-1459 TEST DATE:05/17/05 WORK ORDER NUMBER715 8 0 0 0 CLIENT:CUMBERLAND FARMS SITE:CUMBERLAND FARMS #2142 COMMENTS PRODUCT LINES, 2, TESTED TIGHT AND SAME PRODUCT LEAK DETECTORS, MECHANICAL, ARE OPERATIONAL WHEN MANUALLY TRIPPED. PRESSURE DECAY TEST PASSED, PLEASE SEE PR DECAY COMMENTS. P/V VENT CAP PASSED, PLEASE SEE PR DECAY COMMENTS. BACK PRESSURE AND WET BLOCKAGE TEST PASSED. A/L RATIO TEST PASSED DISPENSERS, # 1 - 7 AND 9 - 12, PLEASE SEE ALSMART SHEET. TANKS ARE MANIFOLDED WITH A VAPOR BAR, STAGE I - 3" X 4" AND ONE THREE INCH VENT. PARTS REPLACED 0 51 hov Ur ggtl _ .., .., , N", HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) s� R r I7ERrtSE$TEo r , » UUAA P NPOINZ4 EST R-S9UTtS� all Printed 05/19/2005 13:07 KOHLMEYER r SITE DIAGRAM P,Tanlawfogy 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 (512)451-6334 FAX(512)459-1459 TEST DATE: 05-/17/05 WORK ORDER NU MBER7 15 8 0 0 0 CLIENT:CUMBERLAND FARMS SITE: CUMBERLAND FARMS #2142 REGIONAL OFFICE CUMBERLAND FARMS #2142 8K 8K 8K 389 W. MAIN ST. 8K REG REG REG HYANNIS, MA SUP UL UL UL F F F F SHOPS V V V V X A A A STP ATG STP SYPHO SYPHO VENT Printed 05/19/2005 13:07 KOHLMEYER A/L VACUSMART Stage II Vapor Recovery _ 9 P Testing Results Facility Name: CUMBERLAND FARMS 42142 Testing Using Facility Address: 395 WEST MAIN STREET, HYANNIS, Hasstech Vacusmart Test Date: 05/17/2005 Alternative to TP-201.5 Work Order: 7158000 Test Unit S#: VS-0434 Testing Tech:John E. Degutis Representative:Je Degutis System Type: DRESSER WAYNE VAC Disp# Grade A/L 'GPM P/F Comments 1 UL 0.93 9.60 P NOZZLES ARE 11 VAI 69 (1), 12V W(6)AND RICHARDS (5). PL 0.96 10.00 P SU 0.96 10.00 P 2 UL 0.99 8.97 P PL 0.98 9.79 P SU 0.98 8.97 P 3 UL 0.93 8.80 P PL 0.91 9.23 P SU 0.93 8.89 P 4 UL 0.98 9.59 P PL 1..00 9.69 P SU 1.00 9.14 P 5 UL 0.98 8.13 P PL 0.98 8.97 P SU 0.95 9.05 P 6 UL 1.03 9.60 P PL 0.97 10.00 P SU 0.98 110.00 P 7 UL 0.98 9.23 P PL 0.92 8.06 P SU 0.93 7.68 P 8 UL 0.00 0.00 F LOW VAC ALL PRODUCTS/TRIED NEW NOZZLE PL 0.00 0.00 F POSSIBLY VAC MOTOR OR ANOTHER PIECE OF HANGING SU 0.00 0.00 F 9 UL 0.96 8.88 P PL 0.96 10.00 P SU 0.98 9.60 P 10 UL 0.90 8.88 P PL 0.90 9.79 P . SU 0.91 8.57 P 11 UL 0.92 8.06 P PL 0.94 8.34 P SU 0.95 8.13 P 12 UL 0.97 8.27 P Page 1 A/L VACUSMART Stage II Vapor Recovery Testing Results Facility Name: CUMBERLAND FARMS#2142 Testing Using Facility Address: 395 WEST MAIN STREET, HYANNIS, Hasstech Vacusmart Test Date: 05/17/2005 Alternative to TP-201.5 Work Order: 7158000 Test Unit S#: VS-0434 Testing Tech:John E. Degutis Representative:Je Degutis System Type: DRESSER WAYNE VAC Disp # Grade A/L GPM P/F Comments P L 0.94 8.34 P SU 0.98 8.27 P Page 2 Mail completed forms with test results to: Charlotte Stiefel, Barnstable County Dept. of Health &the Environment, Box 427, Barnstable, MA 02630 TIGHTNESS TEST SUMMARY REPORTING FORM FOR BARNSTABLE COUNTY Testing company: Tanknology-NDE Phone:, 1-512-451-6334 Date of test: 05/17/2005 Site name: CUMBERLAND FARMS#2142 Location: 395 WEST MAIN STREET,HYANNIS Site phone: 508-790-0227 Name of contact person at site: MGR / NICK TANK TYPE OF PRODUCT TANK PUMP SYSTEM TEST SEPARATE TEST METHOD NAME LEAK RESULT: # SIZE TYPE (tank and lines LINE TEST RATE PASS/ (gals) '(E,N,P) together)Y/N Y/N (gph) FAIL 1 REG UNLEAD 7648 NONE No Yes TLD-1 2. REG UNLEAD 7648 NONE No Yes TLD-1 3 REG UNLEAD 7648 PRESSURE No Yes TLD-1 4 SUPER 7648 PRESSURE No Yes TLD-1 LINE TYPE OF PRODUCT ORIGIN SEPARATE TEST METHOD NAME LINE PUMP LEAK RESULT: LEAK DETECT # AND DISPENSER (TANK TANK TEST TEST TYPE RATE PASS% OPERATIONAL? LOCATION #) Y/N PSI "(E,N,P) (gph) FAIL Y/N or N/A 1 REG 1 No NONE 2 REG 2 No NONE 3 REG 3 No 60 PRESSURE 0.006 PASS Yes 4 SUPER 4 No 60 PRESSURE 0.006 PASS Yes "E=European suction system(only one check valve,at dispenser),N=non-European suction system(check valve at tank,P=pressurized system COMMENTS: l JOHN E.DEGUTIS certify that the above information is true and correct, and that the tests were carried out technician name and certification number C� according to the testing equipment manufacturers'.guidelines. Signature: ` ,�„ , k Date: 05/17/2005 �.. . 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'^`� s�'�,�'...,,�'' .:r,s � Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 i Work Order: 7158000 ' , _ ✓ ,�.. �s`sy ,?"r°b`5 e�p.ah .R „{ `' -�k�g5Pli ll � y��i [Md F e z 114f trou an e� ;ate [,mm ,vytx d 3sP d ' c✓ � AAA� �y,@p �.� y�.+YKJ �E,i MR " A s �kBitSEitbi�YetlirCf4fC1C� CD t1R815dG1314�T# 52P! { 101 MCI _ � E t Kz- i � s ' >u dam; ��a�a.r-a ��"1 �. �ti r ��'� w � "� 'a�� m '� �°, "s,+- � '/ •`' I 41 Xcy � sDN1FIFONLY }h8 fit(legd EQtsrdrrcn theiirk? € A � # { �>�- v �� ��.e3.a�€� '" � a� 3 zr �' c If SMlz, .<us ..�fi7{f 'n �-Ca`t ,, 53 9 �aLL x 1St �eRtCy�ht�mfiFi a 83st a a Fi �,raya =t 3.a� rr �a ate , es2 DEL Int1Yaataflk eaa Y> �lSd `IFI fPClt '� Fw � g�{ Fzl! c - --rr ,c'' a "s. a' a �6at f3 Y is s ap�k�l# i++ tflKt4 !�EiPCe$pll��$f @f mitlirttti # Ii�er t , t '- ;r g u '�[11aF�sv7g ai G a Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 Work Order: 7158000 g � � � s a� owl�z c �V $� ALL s# eoua!-1Z;P`manitvrat {P�3 ohs�am at€�d remits tr ue tank nac## g_ � "` �3Ki �., 117 el , AL eik pad3t 4 �P�+ Y Itte 'icsa4i3€ 7a t aH4tt�l GAt�IR1eT!#S am UT 71 E1 ALt 1dilat��l�4tGttl4itROd&1A0t tBtiB ?SRI ro 3 7I b ' � a 1 72Q ry A$@ tTttQLIS PPfB#aril d* #t!�y ISCG�d° a r mom Aim WW > XL lsra�reaklj �iainars ta6etEaar�awast ° �r� CiH18t13Cts -�xz� .� >? 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HYANNIS,MA 02601 DEBBIE REBELLO MGR / NICK (800)225-9702 ext 3378 (508)790-0227 TEST TYPE: TLD-1 Product Pipe Ti htness Test Results .;, ,-w a `�" .� f; ' T IMP..AC7'NE T "' fST RESU NAL LfAKRA' {9Ph O MAT RgAE TIPS "GG�Z. _ ';Tay.. �' ' EztiY�h•\ ilk syphon I REG UNLEAD syphon 2 REG UNLEAD STP 3 REG UNLEAD 4 SUPER Existing Line Leak Detector Test �EX15IN LEt1Kj�E�TtEC�TOR�#�1 LINE MANUFACTtRR MCiDLSERIAI,# ` QXiv %may D 2 RESU T =MP NUFACjT1URER " MODMUSM EL1k )✓ftl t.1; RESi! syphon 1 syphon 2 STP 3 4 New Replacement Line Leak Detector Test ZW 1RfPEACED LEAK D.ETEC�TOR#1 REPLACED LEAK DETECTOR#?' ` e ��'=� cMANUFACfl1RER M DEL zqr Mw :MANUFACTI�RER -� MODEL# S, RIAL# as RESt1L7 SERIAL� ' E2ESUL ....�.- �n .:�. c,,.« For owner detailed report information,visit www.tanknology.com and select On-Line Reports-WRAP,or contact your local Tanknology office. Tester Name:MICHAEL PASSANTE Technician Certification Number:10101 Printed 06/07/2005.17:44 KOHLMEYER PIP Tc-3nkrK*W 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 (512)451-6334 FAX(512)459-1459 TEST DATE:0 6/0 2/05 WORK ORDER NUMBER715 8 7 3 7 CLIENT:CUMBERLAND FARMS SITE:CUMBERLAND FARMS #2142 COMMENTS AL RETEST # 8 PASS PARTS REPLACED QU�AN11 1' 1 D SGURIPT3Oh11 y r .^.$bra$s .✓'i, ...l✓u WiYBkrl .fWa ,„ HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) 11 kI'll " a e '.,r r ro.r � ��� "w1 �s & � � a'�. fit'v � r��t'k... �c� •'�`� a.�ca`a- � s 3 yw�., . � ELIUM P�tNPOIh(T�LEAK�TEST�ESULTS � t Printed 06/07/2005 17:44 KOHLMEYER s�. � '. SITE DIAGRAM Nl P Tanknology 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 (512)451-6334 FAX(512)459-1459 TEST DATE: 06/02/05 WORK ORDER NUMBER7158737 CLIENT:CUMBERLAND FARMS SITE: CUMBERLAND FARMS #2142 C -F REGIONAL OFFICE CUMBERLAND FARMS #2142 8K 8K 8K 389 W. MAIN ST. 8K REG REG REG HYANNIS, MA SUP UL UL UL F F F F SHOPS V V V V X A A A STP ATG STP SYPHO SYPHO o VENT Printed 06/07/2005 17:44 KOHLMEYER AIL VACUSMART . Stage II Vapor Recovery Testing Results Facility Name: CUMBERLAND FARMS#2142 Testing Using Facility Address:' 395 WEST MAIN STREET, HYANNIS, Hasstech Vacusmart Test Date: 06/02/2005 Alternative to TP-201.5 Work Order: 7158737 Test Unit S#: Testing Tech:Michael Passante Representative: System Type: WAYNE Disp# Grade A/L GPM P/F Comments 8 re9 1.01 8.42 P 8 plu 1.05 8.97 P 8 pre 0.99 - 8.64 P. Page 1 Zip�� TANKNOLOGY CERTIFICATE OF TESTING 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 TELEPHONE(512)451-6334 FAX(512)459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE. 06/15/06 WORK ORDER NUMBER: 7158903 CUSTOMER PO: CLIENT: CUMBERLAND FARMS SITE:CUMBERLAND FARMS#2142 777 DEDHAM STREET 395 WEST MAIN STREET CANTON,MA 02021 AND SUOMI RD. HYANNIS,MA 02601 DEBBIE REBELLO MGR i NICK (800)225-9702 ext 3378 (508)790-0227 Tank Ti htness Tests Results TEST TYPE: VacuTect a EST RESU7 E;`T�ANIC� - �: PRO UCH yl[) CAPACITgY (DCAIUIETE , ATERI L , y EI%EI_ . WASTER E1/EL syphon 1 REG UNLEAD 7,648 90.00 FIBERGLASS^ 49.00 900.00 PASS syphon 2 REG UNLEAD 7,648 90.00 FIBERGLASS 50.00 900.00 PASS STP 3 REG UNLEAD 7,648 90.00 FIBERGLASS. 50.00 900.00 PASS 4 SUPER 7,648 91.00 FIBERGLASS 46.00 900.00 PASS . *Where regulations require,for VacuTect external water level may be depth of dry well or water is assumed at lowest point that can be confirmed dry. Product Pipe Ti htness Test Results �� � IMPACT , � 4 � �TE�SULT� ;� FI�tAL L`EA RATI= �{Sphl VLVE III 7ER Alt PE gMET O • qua, . «u.,, A B . ' ::.�., sb�. � ..f ,,,Ss,..,w...:P• ... aA a' ui� w,'fif�'�Y,e. syphon 1 syphon 2 STP 3 4 Existinq Line Leak Detector Test E3(ISTL1l+iG LEAK �-T.� +1 EXISTII!ISG,E FK DT�ECTQR�2: ...'; y M' IN .. pL SERI,A # RESUtT 4T RED MOQEI�# SERIAL# 'R)=SULI MAMA TURERF ' II O syphon 1 syphon 2 STP 3 4 New Replacement Line Leak Detector Test REP 'AGED LEA DET CToR#1 , , "k! EPLAGED EAK4DETECTORV F & " LINE f � F - : Mi4NUFRC URE MOQEi# SERIAL# RESULfi MANUFACTURER MODEL# SERF# RI=SULTi For owner detailed report information,visit www.tanlmology.com and select On-Line Reports-WRAP,or contact your local Tanlmology office. Tester Name:ANCIL ANTOINE Technician Certification Number:10044 INDIVIDUAL TANK INFORMATION AND TEST RESULTS 2 r Tankno%gy TEST DATE:06/15/05 8501 N MOPAC EXPRESSWAY,SUITE 400 WORK ORDER NUMBER.7158903 CLIENT:CUMBERLAND FARMS AUSTIN,TEXAS 78759(512)451-6334 SITE:CUMBERLAND FARMS #2142 Tank ID: -syphon 1 Tank manifolded: YES Bottom to top fill in inches: 129.0 Product: REG UNLEAD Vent manifolded: YES Bottom to grade in inches: 135.0 Capacity in gallons.- 7,648 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 90.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 281 Overspill protection- YES Stage I vapor recovery: DUAL Material: FIBERGLASS Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS ATG TLS-350 014�..�. EST 7AMKT RES ,est Me#hod�tacuTeot LEaK DETECfQ E t�`S ,�fyr efhoct�. w Start(in) End(in) Dipped Water Level: 0.00 0.00 New/passed Failed/replaced New/passeda Failed/replaced Dipped Product Level: 49.00 49.00 L.D.#1 L.D.#1 L.D.#2 L.D.#2 Probe Water Level: -0.038 -0.038 Make: Ingress Detected: Water N Bubble N UllageN Model: Test time: 10:12-11:34 S/N: Inclinometer reading: 0.00 Open time in sec: VacuTect Test Type: Manifolded tank Holding psi: Resiliency cc: NOT NOT VacuTect Probe Entry Point: Fill Test leak rate ml/m: TESTED TESTED Pressure Set Point: -0.97 Metering psi: Tank water level in inches: 0.00 Calib. leak in gph: Water table depth in inches: 900.00 Results: Determined by(method): NO WELL Result: PASS COMMENTS COMMENTS tank test pass. .s Material: FURON Diameter(in): 1.5 Length(ft): 15.0 Test psi: Bleedback cc: Test time(min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: NONE Pump make: NONE COMMENTS Impact Valves Operational: Printed 06/20/2005 12:54 INDIVIDUAL TANK INFORMATION AND TEST RESULTS i Tanlawfogy TEST DATE:06/15/05 8501 N MOPAC EXPRESSWAY,SUITE 400 WORK ORDER NUMBER.7158903 CLIENT:CUMBERLAND FARMS AUSTIN,TEXAS 78759(512)451-6334 SITE:CUMBERLAND FARMS #2142 Tank ID: syphon 2 Tank manifolded: YES Bottom to top fill in inches: 129.0 Product: REG UNLEAD Vent manifolded: YES Bottom to grade in inches: 135.0 Capacity in gallons: 7,648 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 90.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 281 Overspill protection: YES Stage I vapor recovery: DUAL Material: FIBERGLASS Installed: ATG Stage 11 vapor recovery: ASSIST CP installed on: / 1 COMMENTS atg,tls-350 ��"ANlC�TESTRESLTSest[t le od'VacuT eta; �LFEA��13�TECT'O�ELT�EST ESIIL�'�S �.� est�r�n�e� o�d� 'T ,,...; � Start(in) End(in) Dipped Water Level: 0.00 0.00 New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: 50.00 50.00 L.D.#1 L.D.#1 L.D.#2 L.D.#2 Probe Water Level: -0.009 -0.009 Make: Ingress Detected: Water N Bubble N UllageN Model: Test time: 10:12-11:3 4 S/N: Inclinometer reading: 0.00 Open time in sec: VacuTect Test Type: Manifolded tank Holding psi: Resiliency cc: NOT NOT i VacuTect Probe Entry Point: Fill TESTED TESTED Test leak rate ml/m: Pressure Set Point: -0.97 Metering psi: Tank water level in inches: 0.00 Calib. leak in gph: Water table depth in inches: 900.00 Results: Determined by(method): NO WELL Result: PASS COMMENTS COMMENTS tank test pass. Material: FURON Diameter(in): 1.5 Length(ft): 15.0 Test psi: Bleedback cc: Test time(min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: NONE Pump make: NONE COMMENTS Impact Valves Operational: Printed 06/20/2005 12:54 i INDIVIDUAL TANK INFORMATION AND TEST RESULTS ZI P,Tanlviology TEST DATE:06/15/05 8501 N MOPAC EXPRESSWAY,SUITE 400 WORK ORDER NUMBER.7158903 CLIENT:CUMBERLAND FARMS AUSTIN,TEXAS 78759(512)451-6334 SITE:CUMBERLAND FARMS #2142 Tank ID.- STP 3 Tank manifolded: YES Bottom to top fill in inches: 129.0 Product: REG. UNLEAD Vent manifolded: YES Bottom to grade in inches: 135.0 Capacity in gallons: 7,648 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 90.00 Overfill protection: YES Fill pipe diameter.in inches: 4.0 Length in inches: 281 Overspill protection: YES Stage I vapor recovery: DUAL Material: FIBERGLASS Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS ATG TLS-350 A RI/ v�necL4ECDTECI�OR�ESTRSU estmettodF�TA� Start(in) End(in) Dipped Water Level: 0.00 0.00 New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: 50.00 50.00 L.D.#1 L.D.#1 L.D.#2 L.D.#2 Probe Water Level: -0.012 -0.012 Make: Ingress Detected: Water N Bubble N UllageN Model: Test time: 11:42-13:02 S/N: Inclinometer reading: 0.00 Open time in sec: VacuTect Test Type: Multiple tanks Holding psi: Resiliency cc: NOT NOT VacuTect Probe Entry Point: Fill Test leak rate ml/m: TESTED TESTED Pressure Set Point: -0.89 Metering psi: Tank water level in inches: 0.00 Calib. leak in gph: Water table depth in inches: 900.00 Results: Determined by(method): NO WELL Result: PASS COMMENTS COMMENTS TANK TEST PASS • / NEE ESTRSU TS T st ; pew 1LD z. rs E Material: FURON FURON Diameter(in): 1.5 1.5 Length(ft): 150.0 75.0 Test psi: Bleedback cc: Test time(min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE PRESSURE Pump make: RED JACKET RED JACKET COMMENTS Impact Valves Operational: Printed 06/20/2005 12:54 INDIVIDUAL TANK INFORMATION AND TEST RESULTS TEST DATE:06/15/05 8501'N MOPAC EXPRESSWAY,SUITE 400 WORK ORDER NUMBER.7158903 CLIENT:CUMBERLAND FARMS AUSTIN,TEXAS 78759(512)451-6334 SITE:CUMBERLAND FARMS #2142 i .,,-,b;, ,,,, ,,.., ten,_ .,m tea• u.,saxes=vax,ri, :':ic �L.. �.. Tank ID: 4 Tank manifolded: NO Bottom to top fill in inches: 129.0 Product: SUPER Vent manifolded:YES Bottom to grade in inches: 135.0 Capacity in gallons: 7,648 Vapor recovery manifolded: YES Fill pipe length in inches: 39.0 Diameter in inches: 91.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 294 Overspill protection: YES Stage I vapor recovery: DUAL Material: FIBERGLASS Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS ATG TLS-350 �.;,x� . ��ES L7S Vest MetFtad�lacu'T,ect„ ,; � T �LEA D1=TEC�TQR EST�RE LDS ' ,l"e� � ��F� 1 r , Start(in) End(in) Dipped Water Level: 0.00 0.00 New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: 46.00 46.00 L.D.#1 L.D.#1 L.D.#2 L.D.#2 Probe Water Level: 0.009 0.009 Make: Ingress Detected: Water N Bubble N UllageN Model: Test time: 11:42-13:02 S/N: Inclinometer reading: 0.00 Open time in sec: VacuTect Test Type: single tank Holding psi: Resiliency cc: NOT NOT VacuTect Probe Entry Point: Fill Test leak rate ml/m: TESTED TESTED Pressure Set Point.- -0.89 Metering psi: Tank water level in inches: 0.00 Calib. leak in gph: Water table depth in inches: 900.00 Results: Determined by(method): NO WELL Result: PASS COMMENTS COMMENTS TANK TEST PASS., Material: FURON FURON Diameter(in): 1.5 1.5 Length(ft): 150.0 75.0 Test psi: Bleedback cc: Test time(min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE PRESSURE Pump make: RED JACKET RED JACKET COMMENTS Impact Valves Operational: Printed 06/20/2005 12:54 i i Tankrmlogy 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 (512)451-6334 FAX(512)459-1459 TEST DATE:06/15/05 WORK ORDER NUMBER7158903 CLIENT:CUMBERLAND FARMS SITE:CUMBERLAND .FARMS #2142 COMMENTS ALL TANKS PASS PARTS REPLACED $� QUAN71& y dESCRI�PTi®N� 3 acTm HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 06/20/2005 12:54 KOHLMEYER 9 SITE DIAGRAM i Tanamo/ogy 8501 N MOPAC EXPRESSWAY,SUITE 400 AUSTIN,TEXAS 78759 (512)451-6334 FAX(512)459-1459 TEST DATE: 0 6/15/05 WORK ORDER NUMBER715 8 9 03 CLIENT:CUMBERLAND FARMS SITE: CUMBERLAND FARMS #2142 REGIONAL OFFICE CUMBERLAND FARMS #2142 8K 8K 8K 389 W. MAIN ST. 8K REG REG REG HYANNIS, MA SUP UL UL UL F F F F SHOPS V V V V X A STP ATG STP SYPHO SYPHO VENT Printed 06/20/2005 12:54 KOHLMEYER of Cumberland Farms,Inc. Field Inspection Report/Construction Division Store/Station # 2142 Date 06/15/2005 City: HYANNIS State: MA Work Order#: 7158903 Inspection Performed By: ANCIL ANTOINE If possible, required repairs shall be undertaken at the time of inspection 1. DROP TUBE (STAGE I ) a. Is drop tube present in each tank? Please indicate Yes or No for each tank: Tank 1 Tank 2 Tank 3 Tank 4 Tank 5 YesX No YesX No YesX No YesX No Yes No Comments: b. Is drop tube within 6"of tank bottom? Please indicate Yes or No for each tank: Tank 1 Tank 2 Tank 3 Tank 4 Tank 5 YesX No YesX No YesX No YesX No Yes No Comments: c. Are stricker plates installed? YesX No 2. OPERATION AND MAINTENANCE (STAGE II) a. Vapor Cap/fitting sealed properly? YesX No b. Is gasket working properly? YesX No c Is drop tube damaged? Yes No X Comments: 3. MAINTAIN 99% EFFICIENCY(STAGE II) a. Refer to Daily Inspection Checklist and note any problems detected relative to NOZZLES,HOSES,RETRACTORS, BREAKAWAYS,AND SWIVELS,RAIN CAPS OR P/V VALVES. b. SPILL CONTAINMENT MANHOLES OR SPILL BUCKETS I. Drain valves working properly? YesX No II. Hand pump available? YesX No III. Product in sump? Yes NoX IV. Product removed? Yes No V. Water in sump? yeS No Comments: t c. COMPLETE ADDITIONAL FIELD INSPECTION REPORT ATTACHED. +4.'POST INSTRUCTION (STAGE 1 ) a. Decal on pumps clearly visible? Yes X No b. Indicate whether decal is faded,curling,ripped,etc. c. Was decal replaced during current field inspection? Yes X No Comments: 5. POST"OUT OF ORDER"SIGNS (RED BAG) a. Is there a supply(6) of red "Out of Order"bags on site?yes X No b. If not, have they been ordered? Yes No Comments: 6. 'POST INSTRUCTION (STAGE II) a. Is positive limiting barrier cracked or in need of repair? Yes_ No X b. Is concrete pad cracked? Yes_ No c. Has a fire suppression system been installed? Yes X No d. Is fire marshal's sign posted at sumps? Yes X No e. Is there a handicapped access ramp? Does it meet code?Yes X No f. Is there a designated handicapped parking space? Size? Yes X No _ Size g. Are there exterior telephones? Bumper posts installed? Yes_ No 7. COMMENTS AND/OR OBSERVATIONS MADE ON-SITE: TECHNICIAN SIGNATURE: - Work Order: 7158903 r Nam py , \ b ."k50W,aLe �,�°"W,`..F r^ ON 0 "'D mm :_ dip." �E.t� ��a� Bi�E l j'�yy ,1 Qf�EF � �`z^ �!{�.�$$��,,, l�3►____^ P'4'P'" " ''x j Epd�{s pest`• � �s E�IlP �s � �t0t�'�'� , � � � ,� Nti 4 �a t P e s S ICI 0 j� pry ,; "���� � awe� • �� ��� `� �n �• - �� End 'R �° e� � 1-40, I-EVE jg a , 3 b- S° �s d..,.,_ ":mow.WIN I WIN 110 N X� m Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 Work Order: 7158903 • • � x �' ��t �'�`��!Sy- �, p, �# y � aE F��Eg;W �!� '� a��. � :E��'�; � `���`aR� �-_ E ny y}}�gyy `,ffi� SE E,19H.Pd33 I�t �1r c a I aj i2 tt � � x � Fm =a � IN We s .0 t i�d�l ,ate gl s..._ 3 !me � u xk11 s 3 11 ✓-�a 00 mil �i .�.. Of IESM i �# tied �teE� s � 01441 cd f e � rimx - ga- IN , �£am NMIf�„. , :.;: �.w.�. ..v'� yMx-9n.E: - c'� Cltl �i �, nMEMO, r .6 . �E � t ` *52 Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 i +• Work Order: 7158903 • f sm C - =� igml IN � m� x 4 raujja TIN £r I.ll � d'f.` �'#� UL`t kSt1Sk 0 `11as 1kSdOI[r��' 1 ' � 3 1� LPL ' 9 o OfMW *014 d g z z - � Y ` C�b�[1f4 �rQ�fld'itE€E�3���' ' i INTAN 4101 Peg g° rr�,a jndfed� � NMRMIN � s h„ r .>* ..w��atx«.._ •. , �\`$,'�� "\. fib; g�SS"1°a"�`�4}Ze2 lid sm how UK a f6 �rAl+LSWiels1Ittt6Q N 'fv € � asa ' 111 � a - Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 Work Order: 7158903 • 6 MW as ^ e sC EIN"fill3 I IF Zvi t rrapp rara + h - . &4 .° a dryol �l —IN a FYI „,waq 7 WP xi[ a S 7 # eRdl MEN - y -76€E S1$�S& �C1�Yi9>Qmill _ 3 . y� Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 Work Order: 7158903 st MES 9-Wj=M0 0 EXqf I"N" MIR TaPict vfte -�No low" " M M 011 Maw' I ...... A Q1,16M -M NO 'M'Y rg IN K PaRsa Q F m 11 M 4""'N M, Y ,' M mn it" Usk! V F� W ol AMC P-10 01" Tanknology Inc. 8501 N.MoPac Expressway, Suite 400,Austin,Texas 78759 Work Order: 7158903 • Ulm Ir z y 3f M s � 8E8� `r� MCI iW r� mM31 *W, ­ s -.. MM�'11�110 �L-42.x ? s Mm .,. 0 NO Tp FM IQ va (t @� VIMWNW gg UEM- V " f � r 5511 .' j i ..& �`� des •' 9 MM - : In LAW IP MWOR siR� � a;•ad�t 'ice £ E s{. �is '.�`".�' ` ✓,r �* �. ,&� �LdCfC3118�,Gt3CffEtl4�Clk6 � u � F < , -r m Tanknology Inc. 8501 N.MoPac Expressway, Suite 400,Austin,Texas 78759 • • • } Work Order: 7158903 ^sz , 'Sit 5M KNOW k � s :1 ictttt€ tttFiti its € i ' see gym€ At oekih ' ripper caps"I �1 e6 0 �1natl R 4"�''� U rUt38� 11d C �r11a6Ei8as y Ta1 iY` s � al - x �� j d —r r - „ 1 t Y � IL arm = TiC7t i i4l Ni BEEFT'HIUMC! t �■ C}E1 VWE MP s Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 h SENT BY: KP LFASEEIJET 3150; 508 8 iMi ; JAN-i10 10:45AM; PAGE 6 c;Aft ']r - 29 fly 0 4'CIe '� �lfli-43B-4549 P,.c: _r. TAR.�� �.(}.. t __ vRJO weSfio `^rib_I IIM�A l�Yp,a; H 4—e . s MONITOR SYSTEM CiltRTIVICATION r: Y Work Order a rA07.4� silt: -- piGn f/: ,9d•F � c Add- ." ..•{, Chr�itimns `down atttoniaticaliy if tltc system detects a leak,fails to operate,or is f ( ) Yes { ) Can Cl Gail onncct. ��� ( Yes TM rsteat to-tioning audible and visual alsrms- ���' i@ r for tl c system is properly idtittificd. 06 1'cs 'I'Iti�:Flreu . ca �� ,,..•.a , Ycs to ( ) Coll c ; • ified operational pe;rnanufacturcr's ptrf4rrnence starsdards. ff z p ` onitorinP, Double Wall ( Single Wall w, x $+todCl: L 5 3Y'c? T /� How many: (}psrstional: � Y4 ) No ( . How t Hy: operational: ( ) Y(� ) No Tc 7: nr `' ---- Y i d5 -•• - n — }s' t Double Walt ( ) Single Wall 5CA, How[Harty: 0prsad0A2l: ��, �{ ) No How emaa yc Opewical ( ) ' No Lieu Leak Dcttclitan (, MhanieaI ( ) Ele.^ionic i eetoc / . Model. ��• f'X s : 3, s, . a t Syttenw. f" A,1Mod& R How many: Operationah ( ) Yes ( ) No ) onrrrrtnts <a' Technician signawm, .: Mti�i.`tMiy T� .�. rxj s; r f • ``®0 Cumberland F A R M S October 8, 2019 To whom it may concern, We are respectfully notifying your jurisdiction of a change that will occur regarding the ownership of Cumberland Farms, Inc. ("CFI") that may impact CFI's current licenses in this jurisdiction. These changes are outlined below and will become effective October 22, 2019. Current State EG America, LLC ("EG America") is a convenience store retailer based in Cincinnati, Ohio. The company was formed under the laws of the State of Delaware as a limited liability company. CFI is a convenience store retailer based in Westborough, MA and a privately-held Delaware corporation.CFI's Federal Employment Identification Number ("FEIN") is 04-2843586. Post-Closing State—Effective October 22,2019 After the transaction EG America will own 100% of CFI's stock. The transaction will close on October 22,2019.As part of the agreement, CFI will retain its name,maintain the same FEIN,and continue to operate under the existing CFI banner. It is our intention that this letter serves as the proper notification for the transaction outlined above and may result in changes to the information on CFI's existing licenses. While CFI's ultimate ownership will change as a result of the transaction, the company will retain its name and FEIN as identified on the current business licenses and related periodic filings. Additionally, all current business operations at the local store level will continue unchanged. Finally, all officers of the company, except for the President, will remain consistent. An updated officer listing and diagram of transaction are attached for your records. As a result of the transaction outlined above,we respectfully request that you update CFI's current, active licenses and accounts,effective October 22,2019. We are working with our tax advisors at Ernst & Young, LLP ("EY") for this transaction. An EY representative will be reaching out to your jurisdiction directly, if they have not made contact already. We sincerely appreciate your consideration in this matter and look forward to your reply. Yours sincerely, Howard S. Rosenstein, SVP, Chief Financial Officer and Treasurer Attachment: Officer Listing Cumberland Farms, Inc. 165 Flanders Road, Westborough, MA 01581 508-270-1400 www.cumberlandfarms.com Cumberland Farms,Inc. Officer Listing as of October 22,2019 Officer Name Title Mohsin Issa President Howard S. Rosenstein SVP,Chief Financial Officer and Treasurer Brian E.Glennon,II Secretary John T.Daly Assistant Treasurer Lyn M. Lustig Assistant Secretary Laura S. Sherman Assistant Secretary Transaction Structure MPT tlfi " a CFI will remain the license holder q,,; r• CFI will maintain ownership of all local stores m w CFI operations are not changing Fresh Sandwiches 0178287 Poorboy Sub bin 0178280 SmkTrk Mtr Jck&SWma o on Wheat 0171408 Deluxe Italian Sub 0178288 Big Poorboy Sub 12in 0178284 DbleStuffTrk &AmerChsonWheat 0178795 Oven RstdTu rke &TomatoOnWheat 0178274 Egg Salad on White 0173537 Deluxe Bacon Club on White 0178813 Tuna Salad on Wheat 0177963 Big Turkey & Cheddar Sub 0178269 Buffalo Ckn Wrap 0178268 Roastbeef & Cheddar on Wheat 0178264 Italian Sub 6in 0176826 Corned Beef & Swiss on Rye 0178285 Turkey & Swiss Pita 0178289 Ham & Swiss on Rye 0178271 Chicken Salad on Wheat 0178282 Trky & American Cheese Sub 6in I Hot Foods 0174080 Pizza Pepperoni Sic 0178250 Sausage Egg & Cheese Croissant 0171393 Soup 16z MU 0178252 Sausage Egg & Cheese Biscuit 0171231 Soup 12z MU 0178253 Sausage Egg & Chs Twister Roll 0178251 Sausage E & Cheese Muffin 0178249 Ham Egg & Cheese Croissant 0178409 Egg Ssg P rJackChsBrkfstBur 0179259 English Muffin wSausa a&Cheese 0171306 Chili 16z MU 0171152 Chili 12z MU 0170763 Hot & Frsh Italian Sandwich 0171403 Hot&FreshChickeriFa'itaFlatbrd 0170825 Hot & Frsh Roast Beef 0170690 Hot & Frsh Turkey & Provolone Fresh Soup Orderable Every Day Refrigerated Product...Heated and Held at stores Bistro Soup made by Vienna New England Clam Chowder Potato Bacon & Cheese Tomato Bisque Wild Rice w/Chicken Northwoods Chicken Numero Uno Chile w/Beans Homestyle Beef Stew Chicken & Dumpling Cuban Black Bean w/Vienna Suasage Beef Barley Italian Wedding Chicken w/Rice Mam's Chicken Noodle Stockpot Vegetable Broccoli & Cheese Nachos 0170026 Nacho Large Tray Kit 7-11 0170025 Nacho Small Tray Kit 7-11 Grill Products 0170033 Big Bite HotDog 4/1 OM 7-11 0170848 GoGo Taco Cheese Taquito 0173874 GoGo Buffalo Ckn Taquito 3z 0170560 GoGoMntryJckCkn Taquito 0170032 Big Bite HotDog 6in8/1 OM 7-11 0171021 GoGo Jalapeno & Cream Chs Taq 0171720 GoGo Steak&Jack Taquito 0170462 GoGo Supreme Omelet Taquito 3z 0172211 HPPepperoniPizzaGrillSnack2.8z 0171670 Cheeseburger Big Bite 0175075 GoGoSsgEggChsBrkfstTaquito 0170035 Breakfast Bite 8/1 OM 2z Fresh Bakery items 0174660 Chocolate Iced Cake Donut 0171961 WO Choclate Iced Long John 0174654 Blueberry Muffin 0173245 Glazed Donut US 0171962 WO Vanilla Iced Long John 0171110 OF Chocolate Cake Donut 0174659 Chocolate Chunk Cookie 0171361 Cinnamon Sugar Twist 0173150 Jumbo Twist 0172704 WO Creme Filled Long John 6z 0173256 BE Apple Fritter US 5z 0173246 Chocolate Frosted Donut US 0173247 Boston Creme Donut US 0173248 BE Coffee Roll 3z 0174657 Cheese Danish 0173149 Glazed OF Donut 0171420 Plain Cake Donut US 0176206 All Butter Croissant US 0171927 Almond Crescent 0172125 WO Bavarian Chocicd Lon John 0174653 Banana Nut Muffin US 0175067 Oatmeal Raisin Cookie US 0175085 Cookie M&M US 0173353 Cherry Cheese Danish 0174470 BE Brownie US 0174981 Walnut Brownie US 0171040 Holiday Cookie ■ Sen; 5 `05a: Pum p Model• 55XX XX12 B526 k PERFORMANCE DATA DISCHARGE PUMPHEAD PRESSURE 55XO 55X1 55X2 55X3 (PSI) FLOW CURRENT FLOW CURRENT FLOW CURRENT FLOW CURRENT (GPM) (AMPS) (GPM) (AMPS) (GPM) (AMPS) (GPM) (AMPS) 70 1 20 ' 0 90 k 1.70 1.30 2.15 1.55 2.45 1.75 60 1 30 i 0 85 a 1.85 1.20 2.30 1.45 2.60 1.60 7 ; 50 1 50 .0 80 r 2.10 1.10 2.50 1.35 2.85 1.50 40 1 75 ;0 75 225 1 0,0 2.75 1.20 3.15 1.35 t; 30 2 00 0 70, 2 45 0 90 3.00 1.10 3.45 1.20 20 2 25,`; 0 60 ". 2:80 0 75 3 45` 0 90 4.00 1.05 10 2 50 0 50' 315 0 60 3 90:,t 0 75 4 50 0 85 OPEN 2 85 0 40 3'60 0 50 4 30 0 65 4 90 0 75 -ti E zed} �i PERFORMANCE MEASURED WITH FLOODED INLET (0 PSI);70'F (21°C)AMBIENT AND WATER TEMPERATURE,AND VOLT AGE CONTROLLED.AT 115 VAC: •POSITIVE INLET PRESSURE WILL INCREASE THE DISCHARGE PRESSURE BY-A SIMILAR <„ AMOUNT, FOR A GIVEN FLOW,,MAXIMUM.INLET PRESSURE I, PSI' SHADED AREA DENOTE&CONTINUOUS'OPERATION CAPABILITY AT DESIGNATED'PRESSORE`AND CURRENT HEAT RISE 200 X THERMAL SHUT-OFF LL 180 /X TEMPERATURE 160 X m a a 140 X b t} k -X-1.75AMPS w f -1.00 AMPS J 120 / J W_ X N s -100 x `� rs O 80 a { 4 60 0 10 20 30 40 50 60 70 80 90 100 110 120 TIME(MINUTES) The shaded area in both the Pefformance.Data.and Heat Rise.charts,.contains pumps with current:levels that•are capable , of running,*ithout periodic cool down Pumps;.ln this category will generally transfer more'water"over sustained periods than those,in the-unshaded areas,whlchare required to shut down while the motor cools Some apphcation_s require max= imum flows at high pressures forrelativelyshort,periods,however,so`,an explanation"of thermaljprotectlon follows; - 1 The Heat Rise graph plots the highest current that can run without ever leaving the Shaded Area in this case 1 00"amps All pumps with lower operating currents;may al`so:--run continuously unless the'surrounding air temperature exceeds+70 F(21,C) ? , 2. The showr1,:Isthe highest'flow and•.pressure model offe'rred the 55X3 At 70 PSI this pump will flow 2 45 GPM drawing 1 75 amps;, 3...The motor driving,all of these:pump`models hasa built in;thermal protector;tFiat wlll'open,sFiuthng off the pump,when tFie'surface temperature'ofahe motor heats'to approximately 145°F. After initial room temperature heat nseas shown;the model!SSX3 reaches"the'shut off temperature after about 8 min= utes of run time,pumping about'20 gallons at 70 PSI. 4. Motors of this size and construction require 20 to 40 minutes of cooling time-before'the thermal protector closes-and re-enemizes,the pump. Cower cur- rent levels heat more slowly,allowing longer run times,but the,cool down time still averages about 30'minutesi at.70'F,ambient temperature. 5. Your application may call for short bursts of.water,consuming far less than the S minutesrof sustained:operation. Startup current exceeds normal run_ ning current,however,so cycling should be limited to 6.times permmute.. ALL PERFORMANCE AND HEAT RISE FIGURES ARE APPROXIMATE `ACTUAL ES`:VALU ';WILL VARY WITH AMBIENT CONDITIONS M'.+b-s'++^�:-?!..msT,,FT''s. ^gt`�,:•��*�.dk:AF-'P«°.St?nR2.zSG.'.?i:33!C.-:Y,.:.:RR:'F4t 0.'•S�i.�'^k?2xF ......Mb'�.iTa'-.s�P'.r^+,1.MGwi 'y..�:',y,;;,.@,'+�£,'..T...mS a."�:3: ..: ''YtT,+s".'?'tN:.%M1 .t �.1.ti<:a,'g,,;..'+riaX+'Xy4.�?R..+'i^ NEENEM mow High Flow System CSR 9437-11 9338-00 s.,w,€z.�.Estra.�..;.i:>:n�..�,,.��.�..::::,,ta„,..a�sc�.-._�.�*-�.�� ..es�.�.,:..�: a.. miS�Y'u.,..z..'�,".,. ,',u.�r.t5.+�..:;;;te.r, ;�.'�i'..sa� One system to provide quality water to high flow fountain dispensers, coffee makers and ice machines BENEFITS • Reduces chlorine and other off-tastes and odors. • Reduces dirt and other particulate matter 1/2 micron and larger in size. • Traps harmful parasitic cysts such as Cryptosporidium-. , • Reduces asbestos fibers. • Increases the overall energy efficiency of foodservice equipment. k% • The prefilter extends the life of the MC cartridges (9437-11). • The IMF cartridge feeds controlled amounts of food- grade polyphosphate into the finished water, inhibiting �- limescale buildup. • Listed under NSF International Standards 42 & 53 9437-1 1 I Includes: K-20 Pre-filter and Low Pressure Alarm Fountain • to 4 carbonators combined with a four pot coffee brewer and ' 1,211 pound ice maker High Flow System CSR: 9437-11 � .. High Flow System CSR: 9338-00 tt� High Flow System CSR w/o LPA: 9437-10 t MC Cartridge: 9612-06 EC210 Cartridge 20 pack: 9534-20 EC210 Cartridge 6 pack: 9534-26 IMF Cartridge: 9498-41 9338-00 I INSTALLATION TIPS OPERATION TIPS • Choose a mounting location which is suitable to support Change precoat filter cartridges the full weight of the system when operating up to (49 - on a regular 6 month preventative maintenance basis lbs.) - when the pressure gauge indicates a pressure • Use a minimum 3/4"water line less than 10 psi when the system is operating. • Never use a saddle valve for connection - or at least annually • Fountain equipment connections are made to the outlet Change the IMF cartridge when the level of white part of system before the IMF feeder inhibitor material drops below the cartridge label. • Coffee brewer and ice maker connections are made Change the prefilter cartridge when excessively dirty. after the IMF feeder; a tee is required Always flush the filter cartridges when changing. • Flush filter cartridges by running water to drain at full flow through the flushing valve for 5 minutes ..u.a.. ,s�i wx. .. "Is";iYri'xs 1 SPECIFICATIONS Low Pressure Alarm Water Outlet for Fountain 9437-11 Dimensions: 34"H x 36V x 8"D 36" Inlet connection: 3/4"FPT Service flow rate: Minimum .04 gpm 0 Maximum 7.3 gpm Pressure: Minimum 20 psi ' IMP 1 Maximum 125 psi (non-shock) 4 Maximum temperature: 100°F (38°C) Water 110V electrical connection required Inlet for Low Pressure Alarm 34" (includes 2-1/2" Shipping weight: 34 lbs. for cartridge Operating weight:49 lbs. change) Mc Mc Mc Mc Flushing Valve Water Outlet for Plumbers note: There is a lateral ice and coffee elevation drop of 1.1"from the left to right stub-outs. Outlet for Fountain Water shutoff Outlet pressure 9338-00 Inlet pressure gauge gauge SPECIFICATIONS 33" Dimensions: 34"H x 33"W x 9"D Inlet connection: 3/4" FPT o Service flow rate: Minimum .04 gpm IMP Maximum 7.3 gpm ° — Pressure: Minimum 20 psi Maximum 125 psi (non-shock) Water — Maximum temperature: 100°F (38°C) 34" Inlet _ s (includes j No electrical connection required for cartridge Shipping weight: 30 lbs. change) Mc Mc iNC Mc Flushing valve Outlet for Operating weight:45 lbs. ice and coffee LIMITED WARRANTY OF PHYSICAL QUALITY If,within eighteen months after manufacture or ten years after purchase(whichever oc- curs first),any part of Everpure,Inc.manufacture which is returned to its factory,ship- IS ping charges prepaid,is found to be defective in material or workmanship in the judge- ment of Everpure's engineers, Everpure, Inc.will repair or replace such part at no W charge,f.o.b.,Westmont factory.Everpure,Inc.however,shall not be liable for dam- Sy,wm T° de dcu ftdWN F ages or delays caused by any defective material or workmanship,or by failure of any dema4one e°ema ANsNSF parts due to normal wear and tear.Everpure,Inc.will not be responsible for products s'°"d'"°ze which malfunction due to user neglect or unauthorized modification. Sable dNn.<2:A°ffi—Eff— NOTE:Some states do not allow limitations on how long an implied warranty lasts,so `�4eld`—R°du the above limitation may not apply to you.similarly,some states do not allow the ex- chwdn°Redudwn.-I Y ppY Y Y Madan) 1F0.-UA clusion or limitation of consequential or incidental damages,so the above limitation or F°w wl°Rnd"awn.cw°° 89.9�%r°dudim d F°Ncwu exclusion may not apply to you.This warranty gives you specific legal rights and you °nnh.nmwan°na"°.w,w° may also have other rights which may vary from state to state. sM dPd W.53:H-M E° M°chen-FNnlwn Und Tu,Mdtly R°d—n Cyal RW.W. Aahes,w R°ducli°n Check for compliance with state and local laws and regulations.Do not use where the water is microbiologically unsafe,or with waters of unknown quality without adequate disinfection before or after the unit. May be used with disinfected water where filterable cysts may be present. I WATER YOU CAN TRUST. EVERPURE,INC. In Europe: In Japan: Distributor in Canada: 660 Blackhawk Drive N.V. EVERPURE (EUROPE) EVERPURE JAPAN,INC. DANAMARK,LTD. Westmont,IL 60559-9005 S.A. 1-8-19,Tsumada Kita, 135 Nuggett Court Tel(630)654-4000 Research Park,Haasrode Atsugi-Shi Brampton,Ontario FAX(630)654-1115 B-3001 Heverlee Kanagawa 243 Canada L6T 5H4 Technical Service Belgium Japan Tel (905)792-2353 (800)942-1153 Tel 32-16-401191 Tel 81-462(23)6563 (800)268-5967 http://www.everpure.com FAX 32-16-402691 FAX 81-462(21)6775 FAX(905)792-2986 ©1992I1997/1999 Everpure,Inc. 3/99 7010-68 f Bag-in-Box Organizational System 06-1 o o;�oo 19f �+b•c. eWdb�' i� *LE LC LC RIB RACK Custom Bib Rack Systems 1 1 s S eP E �C i� � sl C�;tgT p� POWDER COATED BLACK FINISH Customized systems pre-assembled to your company's specifications in multiple configurations. OPTIONS INCLUDE: • Flat or inclined shelves • Single, double, or triple MODULAR FLAT SHELF 18" wide shelves it �( Width: 15" (381 mm) • Top shelves Height: 11" (279.4 mm) i • Pump mounts Depth: 19" (482.6 mm) �v Available top, right or left side MODULAR INCLINE SHELFo� • Castors Width: 15" (381 mm) 1 Box Wide ,5 • Flojet or Shurflo BIB pumps Height: 12" (304.8 mm) • Flojet or Shurflo transfer valves Depth: 19" (482.6 mm) • Lancer and/or Liqui Box connectors • Regulator management systems MODULAR FLAT SHELF NSf, Width: 28" (711.2 mm) Height: 11" 279.4 mm)\ Depth: 19" (482.6 mm) MODULAR Width: 27" (685.5 mm) Height: 12" (304.8 mm) 79° 2 Box Wide Depth: 19" (482.6 mm) a MODULAR j Width: 39" (990.6 mm) Height: 11" (279.4 mm) Depth: 19" (482.6 mm) j MODULAR D Width: 39" (990.6 mm) �9 Height: 12" (304.8 mm) 3 Box Wide Depth: 19" (482.6 mm) LAffCER ADVANCED BEVERAGE SOLUMNS CORPORATE OFFICE 6655 Lancer Blvd•San Antonio,TX 78219•(210)310-7000• 1-800-729-1500•FAX(210)310-7250•www.lancercorp.com "Lancer"is the registered trademark of Lancer•Copyright-2003 by Lancer,all rights reserved. 38-1100 03/03 f . 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Flow Range Open Flow 2 9-4 9 GPM '�;,'-!����!4"�i1.,.-_'---."k"'�l.,-��".��i.,::""1 -�'�,', ",-."—,-"'"--�.,eI1,!,��i'.''."l'.1"v"''''1,.-,'����1--���L�I-'".�-.,,�"'?j."'4 �q':-'&'.',-�""1 ��,,.,d'.��-,�'":,,".�,-i-',�:,,_,""�.�.�.�,-j�,�','., ',l,,','�'�.� -�,�,..,�".i-;,-,-"`,.,' 1'.��" 1"­�,''-L'�,'t�­."--��'.- ."':�'.'-"�-�"o,'' Af,70 PSI 1 2;2 4-oP, r hr j;ti '�-",,,'.v-'�-''.";r:.'��,'f,�;��..�'"�:,I "�i''�'� :..­'�"-:i"� '"..,.'"I'�',�,,14"I.-,'�'-�.,.."-.'.�?�-� COMPLETING THEPART NUMBER: `_o,,��"�f.",I11,�,1"- �,�".�,L1.',1""'.'," e"-.,�11---�'%',T."�',-,;" .-�--'Il''!-_1-"'-I��,'-�.'"�,1��i'��. 1'�.�,n,".-i.'k r,1,N--t''..,;L'"�,_.r1..�"-,��-;��"�-,. -j�I,z x-",�,.'-.""�-,,--,1'�'" -I'�:-�,--"�.'-r­i,��.."�",.,-,,�7-'', '1�4A."_,q� ,�--�",-',.,�..k*�"��%�..���,:,-,.k,���B 1.�-.�.'� ��,-,-'�,'''1�'l 4.�4�,r-��"...'"1�'I,,�I...���,,,,,..,',:�--"�Z,,*,,1.-� �l, .i�-1;�'t':��--��.'�'i Z,�,-'-�,�'L-��. l",I� e��L-"�'''�­-".",""t:''":,i i 4��u.A';��'-",-`,--N-`'"%.-',-.",';]1ll,�'-��'�.��,:,,,�:,--`LII� E'-­;;��-,1�"-�",,'-''�--�,-,",.,".',��Z"�'L',�I,�,-'�I�"..""I".' --.1"':;��;I1-, ,L.'-"4',�' ,.4'����-�.'�-'-"'-,,,�.�-,,,�-",L��'-"-"��N',''..��,��"1;,"-�'�L��:;,-1 -"l-1.:-�'r.'�',,-,�.';'T--"-i�-, '�1�-—�"�"-�--L"­"--"1�'"A,''��',----,,�'-,-�g�1-,��-' �g'%-,�,��,''1,,j��.-"-��W't"'�--."'""- --"�n',.�''­�L'-'-�­r,I.'',-4�,-,.'' '�.'�T,L-" �_�"�-"�, ,'�:4--�,r-.-� .Z--l. ��,-�"�"",.':�'--'�-.`5Z11-�"---��T.," ,"1""'r--`"''"�-r..:,"-:,"",- -�-�- X��z"."�I"i�,I �"�',-I, a.95 55XX XX1j2°''B526ra r 1 , '. 0 0 l T ` ' a, DESIRED SHUT OFF PRESSURE-� , ` '' 0 NONE B' 40PSI D 50PSI F 70PS`" o } g¢ o A - '6 'C 45PSI E 60PSI ,""W"1-" ,'�L� -�?—-;'-%-�-:� �."-�'-'1�.,.-1�_—�' I-,'-'"��2 �'R",'".., ,".;-�':'- I, '-�-.­.'�1-,.-1'-�-�f��,'�-.-",-'r.,Z--,�-'�-.".",-L;,!. �--�.�.I,:'�"'�"', -t�":""�,"-,�.1:1I�--,�-':- • * Oy"y NO CONTROL(1NAIVER REQUIRED)'x ' o' ¢ O 4 58 ,� . - ' PRESSURE-1WITCH CONTROL(STANDARD) a r x ai t t a.# 'f r 1; y k�,. , s''t r ,f,,ram �ivt it t 3vi ti t �,t a"# 19 r{ > > ' A - r SELECT MODEL FROM PERFORMANCE DATA CHART ',;7��'"'L,�1-.."- 1�,T1-,', ,�I'�I t s t Y tt f f v l -�''S/x de 'b'trF'`�^T G<` ,i 'i �`a t: erg•t :rs `7P s �' :fdr•'t" 1.. t t � s A r" 'I ;w j£0� r421'.NPT//IFEMALE1CPOR RTC ,r ..- m z9 {.,-4.,-'���- r ,. c%, -,fir 4 a - t }r as "*',-.I"..*,;-'t r-"q-�1''- ,-_-.-';',-��-,",P,-.���' r ' k`; R n "s;Y's k lyu Y�. f! > s + +s+. 6Ss .i� :i"'t t t_.t�^ , Ih'A,�k� i t. "t k a`roc "p x�. 7,:, . MODEL 551X '' i v $�a tr b s p # ds4 ° r s, < ti tt _ 1 � k f ,r Q d rrs -t SVPE ",--, T["uw S: rz =,� 4 , - �h � f r t �? tr ti. d r x ^rr3n 7+�1 , t' ". r r, r t 4. x 4.84 - ■ MOTOR ,, a �r ,3 _ } �� �� Y y r L. 4 ;� {.E° ,� sett i• r d, 0 0 TYPE 115 VAC, 60 HZ; Permanent Magnet, J P t '1 t e " k'r Fan n+'fir{y' t 4 4 N id t J" 8, b .� Dui f 1 i R e 0 0 f r TotallyEnclosed Non Ventilated ";'-''-M } } •4� 'xb 1'a ;2 ' �,'''s }�1i ixX�`� ' '� 'axe r irx �� � a,�c".G� 'x-!N s"�. x i' i' g fi LEADS - ,s�14,AWG, 12 LONG keen ,�,�?? k d f 4 m ax :k:av,s, t 1 v vhw .+K-.:,,rrt u aty et t"1n"�`.C"a°yam'. 'a�j }' # ,r�,,,,,;, ar;" r t,•„ a >, TEMP LIMITS ;' For User Safety Optimal`Performance and :•} }, A s r' yam,;; 'k r rn "', s'' k {. t ' �- -�V a •� t'x IGk Fa 3aaxl �1�t,t�"l r _t=2;«f`:e -7°" "` -: Lt '� .t�' �. 0 o a 5a`: , ,. .k% r zz4 ,z tt4;1 ,Maw mum M-ot0f. 'j,fy T --*jj otorJis EquiPPed xr a ' M r 6, K r r ywlth a Thermal'Protector that�LImits t,9,M or ' O O tr b S Y t �q..� `k§ - '. x i� f§ y / fi p =2 sz f :� z x FSheIITemperature to 1145°F(63°C);asYShown on i k �, 1 y` the HeatzRise Graph I ' " `_ t O'' O t ti v r` x 2. ° DUTY-CYCLE „ S,ee Heat Rise Graph E MODEL 550X a ? 1 , 1 s k i i t + e ' , r fv �, i ti ; �4`f: r I 4 t i ,. rv� -y".Gi s r .a"."t"t.. ■ �PUMPDESIGN y' ' 5ChamberDaphragm Pump, Self Prirn ng, ;T % r ag _ / Capable of BeingfRun Dry rar Fh:4�`S��u'fU P, �! ti Jl,,al!'ay f� k< 'kn. �, : cf . 1.87 ■ % wi t ., 4 s . nu i � as�r`y�x$`rsy r Iwt4tw rc t �s -TYPICAUAPPLICAT,ION ' Be�eragerand Drinking Water DeUuery, t' Eck .' Rio <t x�+r at "o- nrt wf r u)Z m f $ t kt r a ia�}' s s -'' ,, .�a ', ft t y n "s n N m'f`a�r; t '� �y 5 as v� r c. 3.,.�aa- }N ti '+- -h^ - - _ ;yr 7•.i t tF.-.z:'4� t a a ap M1 .� 41{W+` r 'th uq t i' k � .' '-' r t x■ q 'f - t n t x .f tt` 4 + '4 '* + MATERIALS + r„ K tf =z , r^%, �t` fi fib ni f, {, t $ "' ,�r m t £ r¢w'n"L N,F r .� 'Ix pv.�`Sr `�.c %l"2: 9�`+r -. - 4 a� >s s �} 3HOUSINGSr ! PolYPropYMiene *s L f, Ted r g '>6 apt: # 7{'! ts•`.F1. g �ti t 3 s s $ '- 3i09 2 50 y �F � ; VAL'VES�, �t�,h , " EPDM 3 W"'�k p ,rr ott,. E:nk t.' •'` k ¢ t .,,. t pry a� ` r �, 4''s r�' 1�o i�r as >na{ t'a `� 9: frz DIgPHRAGM %h Santopren�e r- ` V ",, , +.gip , �t-a ® �1tT, STENERS , Stainless Steel w Y 5 F $ "1-5 r� r e'?a 'i i'4x f +* ,,,,:t r ti t 9.05 2 k Sa a x 4 r P x r tS*r sa .ff v� �..ly $iG ast gd.(, i k v"' i s aa a� � a r F "-r .. b , 5 -4 y, y*b 2•e• B J,"gs.#:. Lam! t;ht 1 .Xf' 1 •i .A '.N.SF - - x r x> h z.• w a rf h '}" r Wo s1 k s 1 s '*' rr a a .mar i'x t + k .xa + . LIQUID TEMPERATURE , f#140F¢(60°C}Max , r r ti 2.50 t'x , ?' 'a rr f A ,l r K h"'r � . --""'� , dq' i' t $r rs g .1i u4 s t p� c t - et ,r,�iq g, Yv :1 7 t E .� s F sat ?S ,� 'a wt's '- s� �. 2;36 . F �{ F s S4� r p a tt t hr 1 c�Y 4 SF { s s ■ PUMPLCERTIFICATIONS , NSF Standard�58 1+4 1 t :� the Ae '7=try kS� - # i Y y,,.x k.dF a tSd a ® ® r� 8 t x w ' v s s�` �� �n «,r 1 r Tr a '"'�-�7':'1, �,r.-','"�' _�,��..I.'.,'��I;��1-,'�-,"'��,_,I1,"�.,�' "-,;'-,.--�,"".--,:;,".�'".��*..-."�7,,"!�--',.L"Qz,1't."�"r�-'L..�"��.'I'�.� .�'k�-��.' ," ','�,''�",�,�,"'f� x nr x to + , 3■��PRIMIN"&,CAPABILITIES r,'2 �-wx =- =1 ' ssxoliA s5x1 E ssx2„� � 55X3t+ b u s T s d y -'�-r�-:-'''-'-.FF',.,-,".-I:',-1'--'.: " .- os r s+.wr .a s�� r 4 — ,tx B3 n - r 910 11 w a r P1(FEET�'v.. , r�:, .ka K".,� .r"..+ �.o r�+� '£ " r �: y rh r t F• ■ FITTINGS ,2 xr HOSE BARB SIZE s p a n s a k k b a4 'ti. ,<,SHAPE: 1!2 � 5/8 314 TYPE,. S 4.25 UICKDISCONNECT;.• ':STRAIGHT- ' BS554v BSSSS Bs�56 * ! ar MODE i 5 X ' i,� 'rELBOW BE554, BE 555 BE�i56 5.00 '> a NPT FEM LE iSTRAIGHT MPS 54` MPS 555 PSS56 '1 WEIGHT: 6lbs.. kt� w t Fr M'ODEL551X ELBOW MPE�54 tMPE555y MPE.ri56 'l ..+ 1 � ��.. , ..; � , _ , s, t,la � ., , . Aquatec Water Systems, Inc. IIlll��i'II�IIII 17422 Pullman I Irvine, CA 92614 ® Sales: 949-225-2200 DOCUMENT: D ISSUED: 10/14/99 XX12-B526 14/99 a g U a t e C Fax: 949-225-2222 REVISED: 10/14/99 EPEND01 DN E ur�►ei t DIMENSIONS Countertop unit r`a°:By Width:26 in (660mm) { BEVE0.��E w „PENSEkS Depth: 32.38 in (822 mm) Height:41.4 in(1052 mm) (with merchandiser door) 2 Unit on base cart Height: 75.4 in (1915 mm) (with merchandiser door) ELECTRICAL REQUIREMENTS 1� 215 to 245VAC,single phase;3 wire, 30 amp; uses NEMA#L-630R receptacle Refrigeration unit: 21,000 BTU/Hr, R-404A(50Hz) ,� ���"� � •_ �,��';,� � ���,� 19,000 BTU/Hr, R-404A(60Hz) SPACE REQUIREMENTS r t r. _ Sides or back:2 in (51 mm) minimum Top: 12 in (305 mm) 4-Barrel Dispenser WEIGHT (Shown with standard door.Customized solutions available.) Operating unit:460 lb(208.7 kg) Base cabinet: 80 lb(36.3 kg) SYRUP CONNECTION B 6 Bag-In-Box(BIB) �P Cr \ N MOTORS Beater:(4) 1/6 HP Fan: (1) 1/12 HP WATER REQUIREMENTS 34' <,..• Fresh water, minimum 3/8" supply I]SB)mm� OPTIONAL ACCESSORIES Base cabinet w/casters (Part#12-2899-0001) IBA' 9,5 Leg kit(set of four) (Part#12-2533-0001) Painted or stainless steel side panels Water-cooled unit(as shown) Various door options(see spec sheet) o Remote condenser(see spec sheet) 822.m F�o ETA® GO OR FBD strives for continuous improvements and engineering innovations. Equipment design and/or specifications may change without notice. FBD—Frozen Beverage Dispensers 8161 Interchange Parkway,Suite 115•San Antonio,TX 78218•210.637.2800• 1.866.323.2777•Fax:210.637.2832•www.fbdfrozen.com 08/09 Copyright©2009 by FBD Partnership,LP,All Rights Reserved. 24-2314-0005H Item No. Quantity BEVERAGE-AIR RAGE'P\e / �.:►,���� PO Box 5932, Spartanburg, SC 29304 N MODELS: 1-888-845-9800 Fax# 1-864-582-5083 FOOD PREPARATION http://uvww.Beverage-Air.com SERIES PREP TABLES SPE27-711S SPE27 ELITE SERIES Commercial Refrigeration Equipment WITH SNEEZE GUARD General Specification HOLDS(9)1/9 AND(2)1/6 SIZE PANS SPE27 ELITE SERIES—with Sneeze Guard Assembly All around prep table with enhanced refrigeration system and new and improved grille system for better airflow and less temperature gradient. Improved design envelops cold air around pans and provides uniform temperature distribution throughout the cabinet. Airflow assures that product in open containers is kept below 41OF and above freezing.This translates into increased product shelf life, higher quality food, better food appearance, fresher product and a reduction of bacteria build-up to combat food-borne illnesses. CABINET CONSTRUCTION Exterior construction includes heavy-duty stainless steel finish on front, sides, top, door(s), back, bottom and grille. Sneeze guard assembly constructed of stainless steel and clear plastic. Interior liner is made of anodized aluminum for superior resistance to corrosion. Doors are mounted to face of cabinet on cartridge style hinges permit- ting them to self close under their own weight. Hinges also allow doors to stay open 1200 and permit easy door removal for service and clean- ing if required. A plug in type vinyl magnetic gasket is attached to each door for positive seal. Door handle is made from extruded aluminum with a black anodized finish. It is contoured to permit easy opening of doors with fingers from both top and bottom of handle. Digital ther- mometer on door to monitor interior cabinet temperature. Cabinet insulation is CFC free foamed-in-place polyurethane of two- inch minimum thickness. Six-inch adjustable legs are standard. 3"ADA compliant casters are available. Dual-sided countertop is constructed of stainless steel for added dura- bility. One epoxy-coated steel wire shelf supplied as standard. Will accommodate 9-1/9th size pans and 2-1/6th size pans. Pans furnished are 6" deep and made of polycarbonate plastic and are centered for service on both sides of unit. REFRIGERATION More robust refrigeration system provides added capacity and effi- ciency. Systems are designed using CFC free R134a refrigerant and capillary tube between condenser and evaporator. Recirculated, forced air from evaporator is moved under pans, which are recessed 2" from top of cabinet. Forced air over the condenser is drawn through grille under door as well as the back and bottom of cabinet. Automatic con- densate evaporator is provided to eliminate the need of floor drains. ELECTRICAL CONNECTION CERTIFICATIONS Units pre-wired at factory Designed and tested in 860F ambient to 2009 NSF/ANSI 7 standard to • 11516011 and include 8'long cord and hold food product below 41°F. Food must be pre-chilled before placing i NEMA-5-15P plug set located at rear, into pans. Approvals UL-EPH, NSF7 for Open Buffets, and Canadian bottom left. (CSA). r V uE wn USA d � 1 _ y4 - W j •1 b R 1 COM l 'lerC��a'�t1,5 + S yti a.may'' -n m''\� x- 2R. _. t >. r'. �✓,e s '., t`. a �tt;` _ S,a... � a a 4 r Ya'w - '�,�,.x ��- ",tea s''„ � •� �,'� � ,..�v.-.5uk.�r "_ R.6 �r � �%'� x,��a� - tl� Oyu:,!`o--r~• ...!:,Ff � _l: 4 � Myr ��'�4 �}.� � •C i Ft, r L 'xw � •`" r. ., £ ,fix �� F f i � r*�=�.h -'�:� ��� �r. �" f �r �.rF't `�� rw"k,E_ �vrd r•�:.r �r �` � � � s Yi � "`i..t _ S _sk' ,.s �'- �LS' ° .. '< �'En r i' �4 5.�';'k, r 'x•"k 2 n '§ ��h i '. :as tift - p. @@ .a ,.✓ �� ^'.;:d"� �r,.s'a r46 A ��b 1 � �i .r '� � f�';� � v x '',~4r �' -is 9 a � � ��Q ✓i 8 @ � �"� :�,'n... ,) '-Fp z��"� � XS 6�'k� ��'j'�s4 �a � �. �T �_ 4' � :,a � s -`. #x.. s s� '� d" F3'r6 ,�' � ` ✓"a is rfi ? a�s':•^r'3 i� %?y, � G,.t� u 0 : A 6 . A A . i P• q z✓ "$ gal zx ` pis ✓LLr'. �, �. �" x„�f x° ��186733 '' .i 091 A�� . 4MIN E "` a., 5 X A dem. �r„,a� pro � NlEml 757 AE . __ eap ���am •�, 1700 Watt* . x NE10211 Commercial RTTRI�,M ......... Microwave W4 s - NE1051 Oven • 1700 Watts* of power • 2 magnetrons Technical Specifications (heating elements) Power source:208/230-240V,601-1z,Single phase NE-1056 • Top and bottom energy feed NE Receptacle required:NEMA 6-15R or O • "Grab & Go" door handle NEMA 6-20R F • Large oven capacity: Frequency:2,450MHz gr°I 0.6 cubic feet only 16 5/8"wide Required power:208V(14.3A), 230-240V(13.1A) eyq,� • Chef technical support Output*:1700 Watts ? Outer dimensions:16 Sk"w x 20"d x 13'66'h y : • Fits one 6 tall, half size steam table pan with cover Cavity dimensions:13"w x 12"d x 6'Yh • 60 programmable memory Net weight:61 lbs. • 3 power levels shipping weight:66 lbs. NE-12571NE-1258 • cooking Shipping box size:191lh"w x 24'k"d x 16'Yh,4.7 ft' 3-stage n Timer:Maximum times for each stage of cooking • diagnostics Enhanced nos d a g —Hi and Med. powe =r15 minutes C � ycle counter • —Defrost=30 minutes • One touch start feature To specify a Panasonic • Programmable lock Commercial Microwave Oven: • Easy to clean air filter with reminder The NE-1757 Commercial Microwave Oven meets or NE-1757 exceeds all safety performance and sanitation standards • Stainless steel cabinet& cavity set for commercial food service microwave ovens by: LIL,HHS,FCC and NSF. • Patented safety door seal system Plus,oven shall have output power 1700 Watts*,top and • See-through oven door bottom energy feed,Grab&Go door handle,patented safety door seal system,60 programmable memory, • Removable ceiling splatter shield 3-stage cooking,3 power levels(HI,MED.,DEF.), digital display w/countdown, programmable lock,self- a • Digital display diagnostics,oven cycle counter,stackable,video training and Chefrrest Kitchen technical support. NE-2157 • Stackable *I.E.C.705-88 Test Procedure.Specifications subject to change • Only 61 lbs. without notice. • Will ship via UPS 20" �—16 s�"----I 1 e/16" I— _-: _ 18"h 1 'ha" 35 Z'hs 0 G., (2 f' t NE-2180 fez":- 15`A2, 18'/a„ Panasonic Home and Commercial Products Company Commercial Foodservice Division One Panasonic Way,Panazip 4A 4,Secaucus,NJ 07094 Panasonic TEL:(201)348-5377 FAX:(800)553-0384 IN E•3280 http.1ANww.panasonic.com/cmo ag Star Ma n ufa�et u k 3i, GRILL-MAX( ROLLER GRILLS WITH BUILT-IN BUN WARMER Model 75SZRHB7 Features/Benefits: * The Star Grill-Max®line of roller grills takes presentation and performance to its fullest potential morning, noon and night. * Built-in heated bun drawer saves space, reduces cost and provides sanitary storage of buns. Bun drawers features a lid to seal in . moisture and freshness. ,. * Unique"stadium seating"slanted roller design provides the best presentation of your products increasing sales and impulse � � k purchases. F * Slim-line design provides more grill surface in the same space. s Increased capacity means additional sales and greater profits. • Infinite temperature controls provide more linear heat control for ' better performance. • Easy access control knobs provide sectional heating for front and 75SZRHB7 rear rollers. * Exclusive Duratec®coated non-stick rollers,the best non-stick high performance coating for today's high volume operations. Duratec® rollers meet the demands for improved durability, cleanability and feature superior grip for improved rollability of today's new Roller Grill snack foods. • Seal-Max®, Star's exclusive superior heavy-duty roller bearing and seal combination provides smoother operation, longer life, low maintenance and grease-free internal compartments. Applications: Not only do Star Roller Grills, Bun Boxes and Sneeze Guardsx` combine to make the leading"Hot Dog Center"in the industry, but these versatile units can be used for breakfast sausages as well. Quality Construction: ` Constructed of heavy gauge stainless steel with Duratec rollers with stainless steel sheath elements. Infinite temperature controls for accurate cooking and holding from low to high. Heavy-duty motor pro- vides 360 rotation of rollers with stadium seating. Units have built in bun drawer. Units ship standard with a'6'cord and plug. Accessories: sy Sneeze guards are formed polycarbonate and meet health department . requirements. Warranty: Grill-Max® Roller Grills are covered by Star's one-year parts and laborVC(@us( warranty. E LISTED CERTIFlCATIoN _ ISO 9=:2m 'S Star Manufacturing International Inc.-10 Sunnen Drive-P.O.Box 430129-St. Louis, MO 63143-3800 _ Phone: 800 264-7827-FAX: 800 264-6666-www.star-mfg.com S167/0056 z: ±i I I I , International , GRILL-MAC ROLLER GRILLS WITH BUILT-IN BUN WARMER Model 75SZRHB7 A or tE— B —bit C I6 o ••M . . Dimensions roximate Wei ht (A) (B) (C) Model Capacity Width Depth Height Voltage Wattage NEMA Amps Shipping Installed No. Inches Inches Inches Plug lbs. lbs. 0 75SZRHB7 75 Hot Dogs 35-3/4 28-1/2 15-1/2 240V 2260 6-15 9.4 120 87 48 Buns (90.8) (72.39) (39.3) (53.9) (39.4) Typical Specifications Roller Grill is constructed of all stainless steel and utilizes Duratec non-stick coated rollers and tubular stainless steel sheath elements. Elements are mounted in a fixed and floating system allowing for lateral expansion to minimize warping. Infinite tem- perature controls provide accurate cooking and holding from low to high. Unit has a heavy-duty motor and provides 360e rota- tion of rollers. The rollers are arranged in stadium seating with a slope of 30 to 50. The Roller Grill incorporates Seal-Max®,Star's exclusive seal and bearing combination. Units have a pilot light and 6'lead in cord with NEMA 6-15P. UL-Sanitation to NSF Std.#4 approved and UL listed. Star Grill-Max grills patent#6,393,971 and#6,782,802.Printed in the U.S.A. Due to periodic changes In designs,methods,procedures,policies and regulations,the specifications contained in this sheet are subject to change without notice.While Star Manufacturing exercises good faith efforts to provide information that Is accurate,we are not responsible for errors or omissions in information provided or conclusions reached as a result of using the specifications.By using the information provided,the user assumes all risks in connection with such use. Star Manufacturing International Inc.-10 Sunnen Drive-P.O.Box 430129-St.Louis, MO 63143-3800 Phone:(800)264-7827-FAX:(800)264-6666-www.star-mfg.com I�nt� GRILL-MAC ROLLER GRILLS WITH BUILT-IN BUN WARMER Mode175SZRHB7 Features/Benefits: * The Star Grill-Max®line of roller grills takes presentation and performance to its fullest potential morning, noon and night. • Built-in heated bun drawer saves space, reduces cost and provides sanitary storage of buns. Bun drawers features a lid to seal in moisture and freshness. • Unique"stadium seating"slanted roller design provides the best presentation of your products increasing sales and impulse , purchases. • Slim-line design provides more grill surface in the same space. kk �1 ` Increased capacity means additional sales and greater profits. r • Infinite temperature controls provide more linear heat control for better performance. r * Easy access control knobs provide sectional heating for front and 75SZRHB7 rear rollers. * Exclusive Duratec®coated non-stick rollers,the best non-stick high performance coating for today's high volume operations. Duratec® rollers meet the demands for improved durability, cleanability and feature superior grip for improved rollability of today's new Roller Grill snack foods. * Seal-Max®, Star's exclusive superior heavy-duty roller bearing and seal combination provides smoother operation, longer life, low maintenance and grease-free internal compartments. Applications: Not only do Star Roller Grills, Bun Boxes and Sneeze Guards combine to make the leading"Hot Dog Center" in the industry, but these versatile units can be used for breakfast sausages as well. Quality Construction: Constructed of heavy gauge stainless steel with Duratec rollers with stainless steel sheath elements. Infinite temperature controls for accurate cooking and holding from low to high. Heavy-duty motor pro- vides 360 rotation of rollers with stadium seating. Units have built in bun drawer. Units ship standard with a 6'cord and plug. Accessories: Sneeze guards are formed polycarbonate and meet health department requirements. Warranty: Grill-Max®Roller Grills are covered by Star's one-year parts and laborVC@US( warranty. E LISTED ' CERTIFICATION .. ISO 9001:2000 � f rzc- � z s 1 - � Yq � Star Manufacturing International Inc.- 10 Sunnen Drive-P.O.Box 430129-St.Louis,MO 63143-3800 s Phone: (800)264-7827-FAX:(800)264-6666-www.star-mfg.com S167/0056 " z I Manufacturing International , GRILL-MAC ROLLER GRILLS WITH BUILT-IN BUN WARMER Model 75SZRHB7 A B -� C Dimensions r)ximate Wei ht (A) (B) (C) Model Capacity Width Depth Height Voltage Wattage NEMA Amps Shipping Installed No. Inches Inches Inches Plug lbs. lbs. 0 75SZRHB7 75 Hot Dogs 35-3/4 28-1/2 15-1/2 240V 2260 6-15 9.4 120 87 48 Buns (90.8) (72.39) (39.3) (53.9) (39.4) Typical Specifications Roller Grill is constructed of all stainless steel and utilizes Duratec non-stick coated rollers and tubular stainless steel sheath elements. Elements are mounted in a fixed and floating system allowing for lateral expansion to minimize warping. Infinite tem- perature controls provide accurate cooking and holding from low to high. Unit has a heavy-duty motor and provides 3600 rota- tion of rollers. The rollers are arranged in stadium seating with a slope of 30 to 50. The Roller Grill incorporates Seal-Max®,Star's exclusive seal and bearing,combination. Units have a pilot light and 6'lead in cord with NEMA 6-15P. UL-Sanitation to NSF Std.#4 approved and UL listed. Star Grill-Max grills patent#6,393,971 and#6,782,802. Printed in the U.S.A. Due to periodic changes in designs,methods,procedures,policies and regulations,the specifications contained In this sheet are subject to change without notice.While Star - Manufacturing exercises good faith efforts to provide information that is accurate,we are not responsible for errors or omissions in Information provided or conclusions reached as a result of using the specifications.By using the information provided,the user assumes all risks in connection with such use. Star Manufacturing International Inc.- 10 Sunnen Drive-P.O.Box 430129-St.Louis,MO 63143-3800 Phone: (800)264-7827-FAX: (800)264-6666-www.star-mfg.com r ` VAR STAR GRILL-MAXTm ACCESSORIES SNEEZE GUARDS Features/Benefits: * Star's Sneeze Guards have Ultra clear plastic to provide a clear and appetizing view of products. * Easy installation -fits tightly on sides of Roller Grills- no tools required. * Maintain cooking and warming temperatures more evenly. * One and two door styles available for use as operator only or self-serve applications. * Models are available to fit all new and old style roller grills Grill-Max roller grills (Models 40 and 12 excluded). * UL sanitation and safety approved - Meets Health Department requirements. f' * Heavy-duty polycarbonate material for years of maintenance "t' free service. ' * Pass thru styles available. rya �w * Door access accommodates both operator and self-serve needs. Model 30SG-1 D * Sneeze guards have nesting framework to provide a secure fit for all Star roller grills. Applicaton: These sneeze guards are designed to fit our new style Star Grill-Max roller grills and the old style roller grill models. Complete your needs by adding a sneeze guard to protect yourf� „ products. �� � ry Quality Construction: � '� Star's line of sneeze guards are constructed of 3/16" thick a formed polycarbonate for easy maintenance free service. ' Warranty: Sneeze Guards are covered by Star's one year parts and labor warranty. Model 45SG-FCA with optional SGS Sneeze Guard Shields F L 1 Star Manufacturing International Inc. - 10 Sunnen Drive-P.O. Box 430129-St. Louis, MO 63143-3800 s r Phone: (800)264-7827-FAX: (800)264-6666-www.star-mfg.com s wmafy"�' 3'v. I / I Manufacturing International , STAR GRILL-MAXTM ACCESSORIES ' SNEEZE GUARDS A --g C Dimensions Shipping Model Description (A) A (C) No. Width Depth Height Weight Inches Inches Inches' lbs. (cm) (cm) (cm) (kg) STAR GRILL-MAX SNEEZE GUARDS 20SG-1 D Single Door Sneeze Guard-Models 20&20S 17-1/2" 21-3/8" 9" 12 20SG-2D Two Door Sneeze Guard- Models 20 &20S (44.5) (54.3) (22.9) (5.4) 30SG-1D Single Door Sneeze Guard-Models 30, 30S,30BB, 30SBB 24-1/2" 21-3/8" 9" 15 30SG-2D Two Door Sneeze Guard-Models 30, 30S, 30BB, 30SBB (62.2) (54.3) (22.9) (6.8) 45SG-1 D Single Door Sneeze Guard-Models 45A,45SA,45ABB,45SABB 24-1/2" 29-1/4" 9" 17 45SG-2D Two Door Sneeze Guard-Models 45A,45SA,45ABB,45SABB (62.2) (74.3) (22.9) (7.7) 50SG-1 D Single Door Sneeze Guard-Models 50, 50S,50BB,50SBB 36-1/2" 21-3/8" 9" 20 50SG-2D Two Door Sneeze Guard-Models 50, 50S, 50BB, 50SBB (92.7) (54.3) (22.9) (9.1) 75SG-1D Single Door Sneeze Guard- Models 75A, 75SA,75ABB, 75SABB 36-1/2" 29-1/4" 9" 27 75SG-2D Two Door Sneeze Guard-Models 75A, 75SA, 75ABB, 75SABB (92.7) (74.3) (22.9) (12.2) OLD STYLE SNEEZE GUARDS 25SG-FCA Two Door Sneeze Guard for Models 25 and 25S 23-5/8" 18" 9" 15 60.0 45.7 22.9 6.8 45SG-FCA Two Door Sneeze Guard for Models 45 and 45S 35-3/8" 18" 9" 21 (90.5) (45.7) (22.9) (9.5) 75SG-FCA Two Door Sneeze Guard for Models 75A and 75SA 35-3/8" 27-1/2" 9" 21 (90.5) (12.5) (22.9) (9.5) 40SGA-PT Pass-thru Sneeze Guard for Models 40 and 40S 20SGS Sneeze Guard Shield to replace one door for Model 20 Sneeze Guards . . . . . . . . . . . . . . . . . . . . . . . . . . .2 30SGS Sneeze Guard Shield to replace one door for Model 30 &45 Sneeze Guards . . . . . . . . . . . . . . . . . . . . . . .3 50SGS Sneeze Guard Shield to replace one door for Models 50&75 Sneeze Guards . . . . . . . . . . . . . . . . . . . . . . .4 Note: Sneeze Guard Shields can be added to two.door models to create a pass through model. Dimensions will increase slightly in the depth of the unit. • • - • Sneeze Guard is constructed with 3/16" formed polycarbonate. Units are UL- Sanitation Classified to NSF Std. #4 approved. Printed in the U.S.A. Star Manufacturing International Inc. - 10 Sunnen Drive-P.O. Box 430129-St. Louis, MO 63143-3800 Phone: (800)264-7827- FAX: (800)264-6666-www.star-mfg.com k F WEI �5.; h M"' �x < Star Manufi., E �rin� `darns}{ .: ^` Peristaltic Heated Condiment Dispensers Models HPD 1 S, HPD 1 PS, HPD 1 HS, HPD 1 HPS Models HPD2S, HPD2PS, HPD2HS, HPD2HPS Features/Benefits: •New attractive design in a smaller footprint to fit in locations where space is a premium. High impact plastic keeps the front and sides of the unit cool to the touch. *Patented heating and pumping system designed for safe, efficient and consistant dispensing of Nacho Cheese, Chili and other �, � pouched hot condiments. i *No more pumps to clean and sanitize. Patented peristaltic pump r design evacuates product directly from plastic pouch to plate and F when the ouch is empty, simply discard and easily load new ouch P PtY, P Y Y P in seconds! *95% plus evacuation of pouch reduces waste and saves money. *No mess, no fuss, no more messy#10 cans. Unit dispenses one or two 6 pound pouches while holding additional pouch(es) for pre- n heating. r' - *Unit operates 24/7 - No need to heat and reheat product requiring less handling of product. j *Patented forced air heating system for precise uniform temperature. *Preset temperature control for perfectly warmed product every time. *Available in single or double units, with or without portion control for x Model HPD1 (cheese not included) your specific serving needs. w. _ •High speed motor dispenses 1 oz. every second or choose our standard motor to dispense 1 oz./3 seconds for lower volume - operations. *Double wall construction for quiet and cool operation. *Removable stainless steel drip tray for easy cleaning. *Lighted on/off switch for quick, easy visual confirmation of power. �px_ *Eye-catching colorful merchandising graphics to build impulse sales. Applications: Star Peristaltic Dispensers dispense delicious hot foods such as chili, war cheese, spaghetti sauce, gravies, butter and many other viscous prod- ucts with the touch of a button. Located in convenience stores, con- i cessions, recreational facilities, restaurants, institutions or wherever : 4 you might need to safe) dispense product at the touch of a button. +� . Y 9 Y P p '3 Quality Construction: Model HPD2 ' Star Peristaltic Dispensers are constructed of stainless steel with ABS side panels and door. They feature a patented forced air heating sys- tem for precise uniform temperature control. Adjustable portion control Kis available as an option. The patented peristaltic pump provides evenu ius flow and maintenance free operation. Dispensers come complete with LISTED a 6' cord and NEMq 5-15P or CEE7-7 plug for 230V units. Warranty: Our peristaltic dispensers are covered by Star's one year parts and labor warranty. S Star Manufacturing International Inc. - 10 Sunnen Drive- P.O. Box 430129-St. Louis, MO 63143-3800 Phone: (800) 264-7827- FAX: (800) 264-6666-www.star-mfg.com S257/0012 International ,Star Manufacturing Peristaltic Heated Condiment Dispensers Models HPD 1 S, HPD 1 PS, HPD 1 HS, HPD 1 HPS Models HPD2S, HPD2PS, HPD2HS, HPD2HPS 20 7116 14 5/16----{ 9 7/16--{ • • 26 13/16 Electrical Dimensions Approximate Weight Width Depth Height Installed ipping Nema Inches Inches Inches lbs. lbs. Model Description Volts Motor Watts Amps Plug cm cm cm k k HPD1S Single Hot Food Dispenser 120V 75 RPM 750 6.75 5-15P 9-7/16 20-7/1 26-13/16 36 lbs. 45 lbs. 230V 3.50 CEE7-7 23.97 51.91 68.10 16.34 20.43 HPD1 PS Single Hot Food Dispenser 120V 180 RPM 750 6.75 5-15P 9-7/16 20-7/1 26-13/16 36 lbs. 45 lbs. w/portion control 230V 3.50 CEE7-7 (23.97) (51.91) (68.10) (16.34) (20.43) HPD1 HS Single Hot Food Dispenser 120V 75 RPM 750 6.75 5-15P 9-7/16 20-7/1 26-13/16 36 lbs. 45 lbs. High Performance 230V 180 RPM 3.50 CEE7-7 23.97 51.91 68.10 16.34 20.43 HPD1HPS Single Hot Food Dispense 120V 180 RPM 750 6.75 5-15P 9-7/16 20-7/1 26-13/16 36 lbs. 45 lbs.. High Performance 230V 3.50 CEE7-7 (23.97) (51.91) (68.10) (16.34) (20.43) with Portion Control HPD2S Double Hot Food Dispenser 120 75 RPM 850 8.0 5-15P 14-5/16 20-7/1 26-13/16 50 lbs. 60 lbs. 230 4.25 1 CEE7-7 36.35 51.91 68.10 22.7 27.24 HPD2PS Double Hot Food Dispenser 120 180 RPM 850 8.0 5-15P 14-5/16 20-7/1 26-13/16 50 lbs. 60 lbs. w/portion control 230 4.25 CEE7-7 36.35 51.91 68.10 22.7 27.24 HPD2HS Double Hot Food Dispenser 120V 75 RPM 850 8.0 5-15P 14-5/16 20-7/1 26-13/16 50 lbs. 60 lbs. High Performance 230V 180 RPM 4.25 CEE7-7 36.35 51.91 68.10 22.7 27.24 HPD2HPS Double Hot Food Dispenser 120V 180 RPM 850 8.0 5-15P 14-5/16 20-7/1 26-13/16 50 lbs. 60 lbs. High Performance 230V 180 RPM 4.25 CEE7-7 (36.35) (51.91) (68.10) (22.7) (27.24) with Portion Control Typical Specifications Patented peristaltic dispensers have stainless steel construction with high impact plastic side panels and door. Units have a preset temperature control and an optional adjustable portion control . Dispensers have a patented forced air heating system for precise uni- form temperature. Dispensers have 75 and 180 RPM motor for high output. Units have a lighted on/off switch and removable stain- less steel drip pan. Patented peristaltic dispensers are shipped with a 6 foot lead in cord with a molded plug NEMA 5-15P and CEE7- 7 for 230V units. Units are listed by UL, CUL and..UL-Sanitation Classified to NSF Std. #18. U.S. Pat. No. 6,016,935. Printed in the U.S.A. Star Manufacturing International Inc. - 10 Sunnen Drive- P.O. Box 430129-St. Louis, MO 63143-3800 Phone: (800) 264-7827 - FAX: (800) 264-6666-www.star-mfg.com Wisco Pizza Ovens, Food Warmers, Grills, Toasters, Merchandisers, Food Displays Page I of 2 Merchandisers IV 7 Wisco Industries, ICI .ra.,>. Home © Models 690-25 &690-16 F(ood Warmers PO Box 10 Wisco Oven IN Model 995 Warmer/Merchandiser Oregon, WI 53575-001 C Ovens ® Model 323HH Food WarminglMerc hand ising Phone: 608-835-310 Ovens II Fax: 608-835-827 Merchandisers E-mail: fooddiv@the. Merchandisers II Merchandisers III MerchaurlisersIV MODEL 690 -25 & 690 -16FOOD WARMERS Grills Accessories Customization These warmers utilize circulating heated air to maintain food for extended periods of time. Their versatility is Specifications showcased with a shelving system that allows you to Parts Catalog adjust the shelves to your specific needs. The variety of food items it can accommodate is endless. Features • total height of available shelf space- Available in White only - -- Model 690-25: 23"with 4 shelves Model 690-16: 16"with 2 shelves • adjustable thermostat • temperatures from 80 to above 15OF • stainless steel corners and base • additional shelves available ��- • 2-door"self serve" option available Model690-25 Model690-25 Model690-16 Model690A6 Single Door Double Door Single eD�Do��orr Double Door 1 . 'Vil�iri�itil/ $775.00 $825.00 $702.00 $730.00 MODEL 995WARMERIMERCHANDISER The Model 995 Warmer/Merchandiser provides an ideal environment for promoting and preserving the freshness of soft pretzels, breaded products, vegetables, and other foods that require heat and humidity. Food is kept fresh and warm by moist air that is continuously circulated throughout the cabinet. Curved glass display and mirrored doors maximize product visibility. Features Model 995 • (2)75-watt Teflon-coated light bulbs �� Lit1iW/ r 22-gauge stainless steel base r • glass sides $2;525.00 „ ' . • mirrored sliding glass doors Veri,Sig)ly http://www.thepizzaoven.biz/page55.html 12/1/2008 Wisco Pizza Ovens, Food Warmers, Grills, Toasters, Merchandisers, Food Displays Page 2 of 2 MODEL 323HHFOOD WARMING/MERCHANDISINGCABINETS Designed with the option of utilizing the heat and humidity control, these --, merchandisers have the capability of accommodating a variety of food products for an extended period of time. They are sure to draw eye-catching attention with their sleek, new-age design as well as their ability to hold a point-of-purchase advertisement. The 15 model is manufactured from glass and stainless steel, while the 7" model has glass sides and an acrylic front. ;f A: svt Features • fully adjustable thermostat Model 323-7" • 7 version: temperatures from 80 to 150E • 15"version: temperatures from 80 to above 150E • overhead illumination $825.00 • lift-off door and removable side panels for easy cleaning Photo shows a • 15'version comes with 24ier removable rack Model 323-15" 7" and 15"model • 7" version comes with 3-tier removable rack side by side. [��"y4 $ 955.00 mSiVffnl' [Home] [Wsco OvenJ [Ov_ens] [Ovens II](Merchandisers][Merchandisers ill [Merchandisers.11i] [Merchandisers IV] [Grills][Accessories] [Customization] [Specifications] [Parts Catalog] Online purchase of Food Warmer Division Products (units) is not for Dealers. Dealers need to contact Wisco Industries, Food Warmer Division at 608-835-3I06. Phone: 608-835-3106 7-7 Wi /"o ndu + T'A w�`i.ri "is, Inc. -Fax: 608-835-8273 Inquiry Form fooddiv the.pizzaoven.biz Limited 1nlarran* http://www.thepizzaoven.biz/pdge55.hfml 12/1/2008 Wisco Pizza Ovens, Food Warmers, Grills, Toasters, Merchandisers, Food Displays Page 1 of 2 Specifications r'7 Wi co Industr' ies, In, w xa axe Home PO Box 10 Wisco Oven Oregon, WI 53575-001C Ovens Phone: 608-835-310, Ovens 11 Fax: '608-835-827 Merchandisers E-mail: fooddiv@the Merchandisers 11 s p e c i f i c a t i o n s Merchandisers III The most effective point-of-sale food merchandising combines quick preparation Merchandisers IV with superior presentation. Wisco ovens minimize preparation times, Grills so hot and fresh foods are readily available,while our warmers and merchandisers keep food: Accessories at the peak of freshness to stimulate greater impulse sales. Customization Snecifications _.. Parts Catalog MODEL# DIMENSIONS (inches) ELECTRICAL SHIPPING SHIPPING METHOD WT. I B.. 303 31 h x 223/4w x 223/4d 1200v 1250w 1 1120 Freight 303RT 134h x 22314w x 223f4d 120v 1280w 10.7amps 1120 1 Freight 323HH (7") 1119h x 71/8w x 193/4d JF120v 650w 5.5amps 35 IJUPS 323HH (15") 119h x 151/16w x 193/4d 120v 600w 7.5amps 70 JFuPs -oversize 221/2h x 121/2w x 17d 321 F120v I (open) 600w 5amps 11 11 40 UPS 1326 Fe�x 17w x 171/2d F 0v 1250w 10.4amps 59 UPS 412-5NCT 73/4h x 18w x 15d____ 0v 1450w 12.1amps 20 UPS 495 21 h x 12w x 12d III20v 675w 5. 137 UPS 495G 21h x 12w x 18d amps 120v 675w 5.6 70 UPS -oversize 560 1Oh x 241/2w x 193/4d 120v 1700w 14.2amps IPPS 580-1/580-2 110h x 13w x 13d 120v 195w 1. 130 11UPS -oversize 608-S-1 Ill51/2h x 25w x 17d 120v 1776w 14 170 UPS -oversize 610 171/2h x 231/2w x 321/2d JF120v 2200w 18.3amps 11136 11UPS 616N 91/2h x 221/2w x 15d 115v 1470w 12 145 UPS 680-1 24h x 18w x 18d 120v 260w 2.1amps 70 UPS -oversize 680-3 24h.x 18w x 18d 120y 425w 3.54amps 1170 UPS -oversize 680-4 33h x 18w x 18d 120v 600w 5amps 71 Freight 690-16 25h x 18w x 18d 120v 640w 5.3amps 1170 UPS--oversize 690-25 34h x 18w x 18d 120v 640w 5.3 164 Freight 695C 32h x 181/2w x 181/2d 120v 1440w 12amps 94 Freight 695C-S I 132h x 18112w x 181/2d 120v 1440w 12amps 1194 1 Freight 695C-LTD 26h x 18112w x 181/2d 120v 1140w 12amps 86 Freight 1 1 http://www.thepizzaoven.biz/page8.html 12/1/2008 Wisco Pizza Ovens, Food Warmers, Grills, Toasters, Merchandisers, Food Displays Page 2 of 2 925W I29"2h x 183i4w x 183t4d II120v 946w 7.9amps 1.188 (Freight 995 21 h x 301aw x 31 d 120v 1500w 12.5amps 170 Freight WRAPPERS AND DISPENSERS MODEL# DIMENSIONS (inches) ELECTRICAL SHIPPING WT. LB.. IF 630-1 7h x 12w x 12d 1120v 1500w 12.5amps 13 650 (2 tier) 131l2h x 10114w x 12�12d I 5 650-1 (1 7314h x 81/4w x 123/4d 3 tier) WRAP SHEET SIZE--] PIZZA SIZE SHEET COUNT IF 17009 24"x 24" 1116 inch 1500 17010 22" x 22" 1114 inch 11500 17008 20" x 20" 1112 inch 500 F 17011 16" x 16" 118 inch [Home] [Wsco_Q_en.] [Ovens] L yeOL,.J.l][Merchandisers] [Merchandisers Ill [Merchandisers III] [Merchandisers IVJ [Grills] [Accessories) [Customization [Specifications] (Parts_Catalog] Online purchase of Food Warmer Division Products (units) is not for Dealers. Dealers need to contact Wisco Industries, Food Warmer Division at 608-835-3106. Phone: 608-835-3106 Wisco Industries, Inc. Fax: 608-835-8273 Inquiry Form fooddiv. the_iKzaoven biz Limited Warrant httn://www.theDizzaoven.biz/DaLe8.html 12/1/2008 sh Mix Dispensers BUNN® Fre with 4 or 5 hoppers Fresh Mix Dispensers with 4 and 5 Hoppers ITEM# Features: -- Model PROJECT • Capacity: FMD-4:One,8-pound hopper, FMD-4 three.4-pound hoppers Dimensions: FMD-5: Five,4 pound hoppers 29.3"H x 19.3"W DATE • Large,lighted front graphics for merchan- x 21.2"D dising • 6.4 gallon hot water tank to meet peak serving times • Cup clearance at 7"to accommodate common cup sizes • Electrical and plumbing components easily accessible through front and top • Variable speed motors allow control of product consistency in mixing chamber (.75 to 6.6 grams of powder per second) Model FMD-5 _ • High speed,heavy-duty whipper for Dimensions: • complete product mixing 29.3"H x 19.3"W • Front of machine access to tank drain for x 21.2"D FMD-4 easy service • Key lock on the door prevents tampering i • ETL safety and NSF sanitation listed. • ' • • BUNN' Corporate Offices For current specification sheets and other Features deluxe whipper chambers: 1400 Stevenson Drive information,go to www.bunnomatic.com. Springfield,Illinois 62703 1.Robust whipper to ensure full flavor yield. Phone BUNN recommends the use of our Easy Clear® 800-637-8606 Water 2.Specially designed self cleaning mixing chamber. 217-529-6601 Quality Systems to assure perfect taste. Fax 3.Exhaust fan to siphon off moisture that can cause 217-529-6644 Easy Clear®EQ-11-TL powder buildup. \ Technical Services Product No.:30344.1001 s, ;; 800-286-6070 4.Hot water Internet Dimensions: http://www,bunnomatic.com „ s „ „ dispense for 15/s Hx3/H Wx4 /2 easy clean-out. I Western Regional Office 16431 Carmenita Road, Easy Clear'ED-11-TL _ m 5.Quick disconnecting J f Cerritos,California 90701 1 r Whipper Chamber Product No.:30244.1001 parts for thorough Receptacle Phone prI 0-ring 562-926-0764 Dimensions: sanitizing. �� �I Steam Collector Fax i 14%,6'H x 5'/,6'W X 5%t6 D i Mixing Chamber- 562-926-0858 (for most serving capacities) �- / = Canadian Office Five hopper p 280 Industrial Parkway South model shown. �� ' Aurora,Ontario,L4G 3T9 J1 Phone 905-841-2866 Frother� /�(��_D Fax Chsmpber � Ppense 905-841-2775 BUNN®practices continuous product research and improvement.We reserve the right to change specifications and product design without notice.Such Patents O aw revisions do not entitle the buyer to corresponding changes,improvements,additions or replacements for previously purchased equipment. Apply NS� D5 BUNN® The Mark of Quality in Beverage Equipment Worldwide Dimensions & Specifications Model Product# Volts Amps Tank Heater Total Capacity Cu. Shipping Cord Watts Watts Ft. Weight Attached FM13=4 34900.0002 120 15 170U 18001 4.2 gal/hr 16.3 12O lbs: yes FMD4 34900.0003 120/240 20 3500 3600 8.3 gal/hr 10.3 120 lbs. yes F&I65' 34900.0000 120 15 170V l$00, 4 2 al/hi.• T0:3 .123& yes FMD-5 34900.0001 120/240 20 3500 3600 8.3 gal/hr 10.3 123 lbs. yes Electrical: 120V model requires 2-wires plus ground service rated 120V,single phase,60 hz.120/240V model requires 3-wires plus ground service rated 120/208 or 120/240V,single phase,60Hz. Plumbing: 20-100 psi(138-690 kPa)from a 3/8'(10 mm)or larger supply line. A shut-off valve should be installed in the line before the unit.Install a regulator in line when pressure is greater than 90 psi to reduce it to 50 psi.Supplied with 3/8'(10 mm)male flare fitting. FRONT VIEW 19.30 13.30 FMD-4 FMD-5 BACK VIEW SIDE VIEW 16.60 ------ 21.15 nse so IB 50 I t5.t6 IR16 1 14.86 .E 17 I� 15.68 .{ nb�. All dimensions shown in inches. /,,,,,o-o-d/a//r rnJyr/gburcIafhgm..... d..O,III/spuhl/catlnn.Me--,mart(3nno-(Ma,/r/nro—IPI,n ksk",/nmpmr/n<r....ypor„o,Ilf,,,,.,,,,/„ I„„I. BUNN ITEM# BrewWISE® Dual ThermoFresh® PROJECT DBC Brewer DATE oar r BrewWISE® Brewing System with ThermoFresh® Servers e • Brews 16.3 to 18.9 gallons (61.7 to 71.5 litres) of perfect coffee per hour. • Stores individual coffee recipes so operator can easily brew many varieties. • Coffee extraction controlled with pre-infusion and pulse brew, digital temperature control,and large sprayhead;coffee strength controlled with variable by-pass. • Easy pulse interface allows automatic programming of pulse routine • Operate any combination of BrewWISE®equipment error-free with wireless brewer-grinder interface through the Smart Funnel®. • SplashGard®funnel and optional funnel locks help improve safety. • Black and stainless models available. • ThermoFresh®servers are vacuum insulated to keep coffee hot and fresh for hours. • Create coffee recipe cards with custom recipes, ad cards with messages that display on the brewer LCD, and dedicated funnels for special coffees with the BrewWISE Recipe Writer using your PC (Windows®compat ble). Model Dual TF DBC with 1.5 gallon TF Servers (servers sold separately) Dimensions:35.7"H x 21.8"W x 20.2"D (90.7cm H x 55.4cm W x 51.3cm D) �r: For current specification sheets and other information,go to www.bunn.com. Easy Clear®EQHP-10 BrewWISE®Recipe Writer(BRW) TF Servers Product No.:39000.0004 Product No.: 34444.0001 Product No.: 39550.0001 Dimensions: �„\ 1.5 gallon,Mechanical Gauge, 2Y16' H X 63/e"W x 9'/z'D \ Black 5.56cmHx16.2cmWx24.1cmD Easy Clean'EQHP-10L z, Product No.: 39550.0000 Product No.:39000.0001 1.5 gallon,Mechanical Gauge, Stainless Steel Recipe Card Product No.: 34447.0000 • Program a recipe to be used . ,mom on brewer or grinder. TF Digital Servers Product No.: 39550.0051 Single/Dual Filter Pack Ad Card 1.5 gallon,Digital Gauge,Black Product No.:20138.0000 Product No.: 34448.0000 71 Packed per case:500 ?; " " . Program a message to appear Product No.: 39550.0050 Dimensions: on the brewer's display. 1.5 gallon,Digital Gauge, 5'/4"Base x 41/4"Sldewall %W` Stainless Steel 13.3 cm Base x 10.8 cm Sidewall Model Agency Listing Dual.TF DBC ® MSE E9001.0029C ' ' Dimensions & Specifications � a A� r� . Model Product# Volts Amps Tank Heater Total Brewing Cu. Shipping Funnel Cord Watts Watts Capacity Ft. Weight Locks Attached Dual TF DBC 34600.0000 120/240 27.5 2@3300 6600 18 9 gal/hr 14.6 92 51bs. Yes:'. No Dual TF DBC* 34600.0001 120/240 27.5 2@3300 6600 18.9 gal/hr 14.6 92.5 lbs. Yes No Dual TF DBC 34600.0002 12W240 27 5 2@3300 6600,* 1,8.9 gal/hr 14t6 92:5 lbs. � No No`. Dual TF DBC* 34600.0003 120/240 27.5 2@3300 6600 18.9 gal/hr 14.6 92.5 lbs. No No Dual TF DBC 34600.0004 120)t208 27.4 2@2850 570`0 1633 gal/hr 14.6 92 5 lbs. No No Dual TF DBC* 34600.0005 120/208 27.4 2@2850. 5700 16.3 gal/hr 14.6 92.5 lbs. No No Dual IF DBC 34600.0006 120/208 '27.4 2@2850 5700 16.3 gal/hr ' 14 6 92 5 Ibs: Yes:, No. Dual TF DBC* 34600.0007 120/208 27.4 2@2850 5700 16.3 gal/hr 14.6 92.5 lbs. Yes No 'Models have black decor. Brewing capacity.based upon incoming water temp of 60eF(140°F rise). Models listed as 1201208V or 1201240V must be connected to 208V or240V electrical service respectively.Please refer to the installation manual. Electrical: Brewer is 3-wires plus ground service rated 120/208V or 120/240V, single phase, 60Hz. Grinder is 2-wires plus ground service rated 120V, 60Hz, circuit required, 3/4 HP motor. Plumbing: 20-90 psi (138-621 kPa). Machine supplied with 3/B"male flare fitting. 22.7 00 00 00 00 00 00 � 00 00 C o 35.7 ® ® 23.2 7.1 00 00 00 00 00 00 e e 4.1 18.8 6.4 21.8 WATER SUPPLY CONNECTION 19.0 20.2 Bunn-0-Mati&Corporation-1400 Stevenson Drive Springfield,Illinois 62703.800-637-8606.217-529-6601 •Fax 217-529-6644•www.bunn.com BUNN®practices continuous product research and improvement.We reserve the right to change specifications and product design without notice.Such revisions do not entitle the buyer to corresponding changes,improvements,additions or replacements for previously purchased equipment. All dimensions shown In Inches. Bunn-O-Matic Corporation owns all copyrights relating to materials in this publication.Please contact BUNN to request permission to reproduce anyportion ofthis publication. BUNN® ITEM# PROJECT TF Servers DATE � '4 r y BUNN ThermoFresh® servers • Vacuum insulated to keep coffee hot for hours. • Contemporary styling and wrap program for maximum merchandising. °pK 'Y • Built-in drip tray is easily removed for cleaning. �` • Large cup clearance allows for dispensing into cups, decanters and thermal carafes. • Fast flow faucet. • Brew-through lid. • Integrated sight gauge assembly allows for easy cleaning. • Innovative faucet design. • Improved space saving profile. • Ideal for use with Single or Dual TF DBC Brewers. g I 1 and 1.5 gallon TF Servers Dimensions(1 gal):20.6°H x 9.6"W x 14.1"D (52.3cm H x 24.4cm W x 35.8cm D) Dimensions(1.5 gal): 22.5"H x 9.9°W x 16.3"D (57.2cm H x 25.2cm IN x 41.4cm D) For current specification sheets and other information,go to www.bunn.com. 10 Dual TF DBC Single TF DBC TF Server Handle(orange) Brewer/Server Compatibility Product No.:34600.0001 Product No.:34800.0000 Product No.:39081.0001 1.5 Gal TF 1 Gal TF Brewer w/base w/base ICB No No ICB Twin No No ICB (tall) Yes Yes ICB Twin (tall) Yes Yes ITCB No No ITCB(tall) Yes Yes SingleTF Yes Yes (servers sold separately) (server sold separately) Dual TF Yes Yes Model Agency Listing E9001.0030C ' ' ' Dimensions & Specificat�ons : k Model Product# Volts Amps Total Holding Cubic Shipping Cord Watts Capacity Measure Weight Attached 1 Gal TF Server 39500.0000 n/a n/a n/a 1 gallon 2.8 ft3 13 lbs. No 1 Gal TF Server' 39500.0001 n/a n/a n/a 1 gallon 2.8 ft3 13 lbs. No 1.5 Gal TF Server 39550.0000 n/a n/a n/a 1.5 gallons. 2.8 ft3 14 lbs. No 1.5 Gal TF Server' 39550.0001 n/a n/a n/a 1.5 gallons 2.8 ft3 14 lbs. No Models have black decor. 121 I I i 20.E I I 7.9 a9 9.J--I 129 111 1 Gal TF Server rp lilt 11111 I.I I I i 229 t 89Li 79 l fl 129 1.5 Gal TF Server Bunri-O-Matic®Corporation-1400 Stevenson Drive Springfield,Illinois 62703.800-637-8606.217-529-6601 •Fax 217-529-6644•www.bunn.com BUNN®practices continuous product research and improvement.We reserve the right to change specifications and product design without notice.Such revisions do not entitle the buyer to corresponding changes,improvements,additions or replacements for previously purchased equipment. All dimensions Shown in inches. Bunn-o-Matic corporation owns all copyrights relating to materials in this publication.Please contact BUNN to request permission to reproduce any portion o/this publication. N.A. 35.940 39.000 O 61.691 22.850 36.000 18.000 ITEM PART NO. DESCRIPTION OTY CUSTOMER: CUSTOMER NUMBER: ROYSTON U-C These designs are 'e`'0 ONE PICKROY ROAD 1. 10008354 LBL,NSF,J,PLNT,6445,MODL,ROY 1 DUNKIN N.A. �.ROYSTON JASPER, 143 proprietary (na1T3s-3ass 2• 10025609 CASE,PSRY,GL,S/L,09 1 information,property oerence ass PARTDEWRIPMN of ROYSTON LLC. Olh—i-N. CAB,S-L,UN IT,A,CASE,PSRY,SKT,PFP4224 t They shall not be .loot=:.ois 3• 43623 BAG,POLY,GUSSETED,2 copied duplicated .pc_:.o30 a MIL,PERFORATED,98X28X50 p H.I. = '° si2ti2oos NONE in any manner without H le t.003 1 prior written consent, DRA NBY PARTF a• s0010741 a,cnB,PSRv,A SHEET 1 OF 1 brian.tendley 23021246 a e \\jasdc.roystonllc.com\se$\TechService\CAB\CAB,S-L,UNIT,A,CASE,PSRY,SKT,PFP4224.dft PRINTED 6/11/2009 N.A. 35.940 39.000 e 61.965 22.850 36.000 18.000 ITEM PART NO. DESCRIPTION OTY CUSTOMER: CUSTOMER NUMBER: RovsTON uc `y' �IF� ONE PICKROy ROAD 1• 10008355 LBL,NSF,J,PLNT,6446,MODL,ROY 1 These designs are DUNKIN N.A. :■RO l ST®1 i �ASPER,GA 30143 proprietary (n0)735-345e 2' 10025609 CASE,PSRY,GL,S/L,09 _ 1 information,property oaranoa ass PART DESCRIPTION of ROYSTON LLC. ahem isanoied CAB,S-L,UNIT,B,CASE,PSRY,SKT,PFP3621 1 They shall not be ' 030 R + 3' 43623 BAG,POLY,GUSSETED,2 copied or duplicated .>oc=:.3o MIL,PERFORATED,98X28X50 p Angles-t1° 5/22/2009 23021246 in any manner without Hole Dia.= 003 i prior written consent, ORAwN Rv PART+ a sooto�a2 A,cAB,PSRY,6 SHEET 1 OF 1 brian.fendley 23021247 \\jasdc.roystonllc.com\se$\TechService\CAB\CAB,S-L,UNIT,B,CASE,PSRY,SKT,PFP3621.dft + PRINTED 6/11/2009 POWSALES CuUNTER AREA Isometric Drawing OTHER/SINKS ( Cream Color Counters)DESCRIPTION Model No. DukeOracle Comments Stand, Ice Cuber, 36"w x 38d x 80"h, Dri-LAC#49-11280, Cream, NSF ICESTD3-38x80-C 500600 For Lancer FS18 01-927840 500601 ak' T �-23i• --'-I - Counter, Black grommet " 01-887010 500602 Counter, Putty grommet Sink,24"w x 24"d x 36'h, 12"_h back and side splashes, Sink 19"Long x 18"w x SK2-24,12BS 500115 Used in Bev Island 725"d, no soap/towel disp., SS Top, 1 Door 24"w x 24"d x 34"h, 124h back and side splashes, 9"Long x 18"w x 7.25"d, no - SK2-24-12BS-ADA 500135 Used in Bev Island :owel disp., SS Top,#49-11280 Dri-Lac, 1 Door,ADA, Sink,24"w x 24"d x 36"h,4"h back and side splashes, Sink 19"Long x 18"w x SK2-24-4BS 500406 Used in Bev Island 7.25"d,no soap/towel disp.,SS Top,#49-11280 Dri-Lac, 1 Door POS/SALES CuUNTER AREA Sink,24"w x 24"d x 34"h,4"h back and side splashes, Sink 19"Long x 18"w x SK2-24-4BS-ADA 500436 Used in Bev Island 7.25"d, no soap/towel disp, SS Top,#49-11280 Dri-Lac, 1 Door,ADA, Sink,24"w x 30"d x 36"h, 12"backsplash 3 sides, 1.Door,Paper towel dispenser, SK2-30-12BS-DISP 500310 Used in Sales area kqrA ova 24"w x 30'd x 34"h, 12"backsplash 3 sides, 1 Door, Paper towel dispenser, SK2-30-12BS-DISP-ADA 500327 Used in Sales area ar-(A Sink,24"w x 30"d x 36"h,4"h back and side splashes, Sink 19"Long x 18"w x SK2-30-46S-DISP 500309 Used in Sales and FF 7.25"d, soap/towel disp.,SS Top,#49-11280 Dri-Lac, 1 Door areas Sink, 24"w x 30"d x 34"h,4"h back and side splashes, Sink 19"Long x 18"w x SK2-30-4BS-DISP-ADA 500326 Used in Sales and FF 7.25"d, soap/towel disp., SS Top,#49-11280 Dri-Lac, 1 Door,ADA areas 1� Sink,24"w x 24"d x 36"h,4"h back and side splashes, Sink 19"Long x 18"w x SK2-24-4BS-DISP 500116 Used in Sales area 7.25"d, soap/towel disp.,SS Top,#49-11280 Dri-Lac, 1 Door Sink,24"w x 24"d x 34"h,4"h back and side splashes, Sink 19"Long x 18"w x . SK2-24-4BS-DISP-ADA 500162 Used in Sales area 7.25"d, soap/towel disp.,SS Top,#49-11280 Dri-Lac, 1 Door,ADA TheTornado TM A TURBOCHEF SPEED COOK OVEN 0 0 03 0 0 0 0 DOD 00D DDD DDD DDD PROJECT ITEM NUMBER MODEL NUMBER QUANTITY CONSTRUCTION o Smart Card capability Exterior 0 Stackable design 0 430 Stainless steel front, top and sides 0 Manual sleep mode 0 4" (102 mm) chrome plated adjustable legs 0 Warranty— 1 year parts and labor D Nickel plated handle o Cool to the touch pull down door ACCESSORIES o Oven Carts-— 18" (457 mm) and 24" (610 mm) stainless Interior steel carts with heavy-duty, bolt on locking wheels for a 304 stainless steel interior reliable performance o Fully insulated Cook Chamber 18" (457 mm) Cart (P/N:TC3-0143-2) o Removable wire cooking rack 24" (610 mm) Cart (P/N:TC3-0143-1) o Adjustable lower cooking element ❑Polymer Cook Tray (P/N: NGC-1207) STANDARD FEATURES CERTIFICATIONS o Recirculating air path with TurboChef Technologies UL, cUL, NSF, FDA, FCC patented catalytic converter system o Multi-speed convection blower 0 '' o Conventional wire baking rack µ. C U� US o Optional bottom baking surface o Independently controlled bottom browning element * "Smart Voltage Sensor Technology automatically senses the supply voltage Smart Voltage Sensor Technology and allows the user to configure the oven to the correct setting(208 or o Programmable with up to 128 cooking programs 240)with the touch of button. �:s.o•� 2s.r 0 0 � 0 0 0 o 0 0 0 0 0 23.0'18.0" o00 000 0 � � O 0 � 0 0 o PLUG —11.25" DIMENSIONS Europe and Asia Markets o Single Units (allow+/-.05" (1.27 mm) tollerance) NGCEW(3 Phase,WYE, 50 Hz) Height 19.09" (485 mm) Operating Voltage 400 VAC on legs 23.03" (585 mm) Current Draw 16 amp o 0 Width 25.9" (659 mm) Phase 3 Phase o Depth 26.06" (662 mm) Frequency 50 Hz with handle 28.06" (713 mm) Plug IEC 309, 5-pin, 32 amp Weight 190 lbs. (86 kg) Heaters Input Power 6300 watts o Stacked Units (allow+/-.05" (1.27 mm) tollerance; Microwave Input Power 3500 watts Stacking Kit optional) o NGCED (3 Phase, Delta, 50 Hz) Height 38.18" (970 mm) Operating Voltage 230 VAC o Width 25.9" (659 mm) Current Draw 30 amp o 0 Depth 26.06" (662 mm) Phase 3 Phase o with handle 28.06" (713 mm) Frequency 50 Hz Weight 380 lbs. (172 kg) Plug IEC 309, 4-pin, 32 amp 0 Cook Chamber Heaters Input Power 6300 watts Height 8" (203 mm) Microwave Input Power 3500 watts Width 15.5 (393 mm) o NGCUK 0 Phase, 50 Hz) Depth 14.7" (373 mm) Operating Voltage 230 VAC o Wall Clearance Current Draw 30 amp o 0 Top/Sides 2" (51 mm) Phase 1 Phase o Back 0" (0 mm) Frequency 50 Hz Plug IEC 309, 3-pin, 32 amp ELECTRICAL SPECIFICATIONS Heaters Input Power 6300 watts North American Markets Microwave Input Power 3500 watts o NGC (1 Phase, 60 Hz) Operating Voltage 208/240 VAC SHIPPING INFORMATION Current Draw 30 amp o All ovens packaged in a double-wall corrugated crate Phase o o banded to a wooden skid Phase 1 P o Crate size(North America): 36"x 3 1"x 31 Frequency 60 ha " Plug 60 Hz (914 mm x 787 mm x 787 mm);NMF Class 85 Max Input NEMA 6-30 o Crate size (International): 34"x 31"x31" Microwave Input Power 5990 watts 675 watts (864 mm x 787 mm x 787 mm); HM Code 8419.81 o Approximate crated weight: 240 lbs. (109 kg) o Minimum entry clearance required: NOTE: Smart Voltage Sensor Technology does not Crated: 31" (787 mm) / Uncrated: 24" (673 mm) compensate for lack of or over voltage situations. It is the responsibility of the owner to supply voltage Turbo Chef reserves the right to make substitutions ofcomponents or change to the unit according to the above specifications. specifications without prior notice. Corporate Headquarters Global Operations Six Concourse Pkwy,Suite 19oo 4240 International Pkwy,Suite 1o5 Atlanta,Georgia 30328 USA Carrollton,Texas 75007 USA ��. +I 678.987.1700 PHONE +I 214.379.6000 PHONE +1 678.987.1750 FAX +1 214.379.6073 FAX Accelerating the World of Cookingr" Sales&Marketing: 866.90rURaO Customer Service. 800.90ruRao Ocrohcr 2005.Printed in the U.S.A. turbochef.com C,un y Co&:NA Project • BOCHEF I� Item No. O X Quantity Z '"' TORNADO EXTERIOR CONSTRUCTION 0 ■ 430 stainless steel front, top, sides and back O ■ 4" (102 mm)adjustable legs ■ Cool to the touch pull down door with microwave seal f INTERIOR CONSTRUCTION u 304 stainless steel interior Fully insulated cook chamber Removable/variable cooking surfaces r.. ■ Exposed bottom browning element K STANDARD FEATURES 7 `"' ■ Integral recirculating catalytic converter for UL 710B (KNLZ) listed ventless operation ■ Variable-speed High h recirculating impingement airflow system PERFORMANCE ■ Variable cooking surfaces (racks, stones and platters) ■ Independently-controlled bottom browning element ■ The Tornado®evenly and ■ Smart Voltage Sensor Technology* (U.S. only) consistently toasts, browns and crisps food up to 12X faster than ' Smart menu system capable of storing up to 128 recipes traditional cooking methods, ■ Built-in self-diagnostics for monitoring oven components resulting in a high level of and performance throughput without compromising ■ Stackable design (requires stacking kit) quality ■ Manual snooze mode ■ Includes plug and cord (5 ft.) ■ Smart card compatible ■ Warranty— 1 year parts and labor COMES WITH STANDARD ACCESSORIES ■ 1 Aluminum Paddle (103284) ■ 1 Bottle Oven Cleaner(103180) { 1 Bottle Oven Guard (103181) ■ 2 Trigger Sprayers (103182) ■ 2 Teflon Baskets (100011) 1. Blower Motor 2. Impingement Heater 3. Impinged Air 4. Bottom Browning Element `' UL US NSF fT 5. Microwave Bursts ANSIINSF#4 81Y5 ( E 6. Catalytic Converter 'Smart Voltage Sensor Technology does not compensate for lack of or over voltage situations.It is the responsibility of the owner to supply voltage to the unit according to the specifications on the back of this sheet.This product conforms to the ventilation recommendations set forth by NFPA96 using EPA202 test method. If you have questions regarding ventiess certifications or local codes please email ventless.help@turbochef.com TurboChef reserves the right to make substitutions of components or change specifications without prior nonce. TurboChef Global Operations 4240 International Pkwy,Suite 105 Carrollton,Texas 75007 USA US: 800.90TURBO(800.908.8726) International:+1 214,379.6000 Fax: +1 214.379.6073 NGC-1299/Revision G/ turbochef.com April 2008 f 26"(660 mm)_� ® I O U°s 25.7"(653 mm) 0 (483 mm) 40 Z �G o 0 0 0 o Do 0 0 23" PLUG (584 mm) O11.25'(286 mm) o G DIMENSIONS Plug IEC 309,5-pin,32 amp Single Units Max Input 10500 watts Height 19" 483 mm Microwave Input Power 3500 watts on legs 23" 584 mm NGCED(NGC-1180-1 D) Width 26" 660 mm Phase 3 Phase Depth 25.7" 653 mm Voltage 230 VAC ° o O with handle 28.2" 716 mm Frequency 50 Hz o Weight 190 lbs. 86 kg Current 30 amp Stacked Units(stacking Kit Required) Max Circuit Requirement 32 amp Height 38" 965 mm Plug IEC 309,4-pin,32 amp Width 26" 660 mm Max Input 10500 watts Depth 25.7" 653 mm Microwave Input Power 3500 watts with handle 28.2" 716 mm NGCUK(NGC-1180-1K) Weight 380 lbs. 172 kg Phase 1 Phase Cook Chamber Voltage 230 VAC o 0 Height 8" 203 mm Frequency 50 Hz O Width 15.5" 394 mm Current 30 amp Depth 14.7" 373 mm Max Circuit Requirement 32 amp Volume 1.05 cu.ft. 29.9 liters Plug IEC 309,3-pin,32 amp Wall Clearance(oven not intended for built-in installation) Max Input 6700 wafts Top 4" 102 mm Microwave Input Power 3500 watts Sides 2" 51 mm JAPAN SPECIFICATIONSELECTRICAL NGCJD-50Hz/3 Phase(NGC-1180-1D-2005-1) NORTH AMERICA NGCJD-60Hz/3 Phase(NGC-1180-1 D-2005-2) /J NGCJK-50Hz/1 Phase(NGC-1180-1 K-2005-3) u NGC(NGC-1180-1) NGCJK-50Hz/1 Phase(NGC-1180-1 K-2005-4) Phase 1 Phase o 3-Phase Phase 1 or 3 Phase Voltage 208/240 VAC o o Voltage 200 VAC Frequency 60 Hz I i q Y Frequency 50 or 60 Hz Current 30 amp Current 30 amp i-Phase Max Circuit Requirement 30 amp Max Circuit Requirement 30 amp Plug/Cord NEMA 6-30P;1.5m,H07RN-F Plug PSE-marked,3 or 4-blade,30 amp Max Input 5990/6675 watts Max Input 10500 or 6700 watts Microwave Input Power 3500 watts Microwave Input Power 3500 watts NGCBK(NGC-1180-1K-2020) S HIPPING INFORMATION Phase 1 Phase o o U.S.: All ovens shipped within the U.S.are packaged in a double-wall Voltage 220 VAC p corrugated box banded to a wooden skid. Frequency 60 Hz International:All International ovens shipped via Air or Less than Container Loads are packaged in wooden crates. Current 30 amp Box size: 34"x 30"x 30"(864mm x 762mm x 762mm) Max Circuit Requirement 30 amp Crate size: 36.5"x 32.5"x 31.5"(927mm x 826mm x 800mm) Plug IEC 309,3-pin,32 amp Item class:85 NMFC#26770 HS code 8419.81 6700 watts Approximate crated weight:310 lbs.(141 kg) Max Input Microwave Input Power 6700 watts Minimum entry clearance required for box: 30"(762mm) Minimum entry clearance required for crate: 31.5"(800mm) EUROPE/ASIA-PACIFIC 'All AU-New Zealand ovens with clips allow for 5 pin plug. NGCEW(NGG1180-1 W for standard) TurboChef recommends installing a type D circuit breaker for all installations. NGCEW(NGC-1180-1W-2024 for Austral ia/New Zealand)' NGCKW(NGC-1180-1 W-2004 for South Korea)" o 0 O Phase 3 Phase Standard Voltage 400 VAC Frequency 50 Hz or 60 Hz" Current 16 amp Max Circuit Requirement 20 amP Australia/New Zealand Item No. ` - Quantity BEVERAGE-AIR AIR RAGE �.�oL�► PO Box 5932, Spartanburg, SC 29304 29" DEPTH MODELS: 1-888-845-9800 Fax# 1-864-582-5083 WTF27A http://www.Beverage-Air.com WORKTOP FREEZER WTF48A FOOD PREPARATION SERIES Commercial Refrigeration Equipment General Specification WTF—SERIES WORKTOP UNITS Versatile, compact (29" deep) models with stainless steel work tops and frozen storage of food products. Working ffx-. height* is 35 1/2". s + CABINET CONSTRUCTIONw Heavy duty construction includes stainless steel on front, IX } m pi BEVERAGE qIR sides, door(s) and grille. Worktop is stainless steel with 4" t removable backsplash. Cabinet back and bottom are galva- nized steel. Interior liner is made of anodized aluminum for longer lasting corrosion protection. Interior thermometer is standard. r Cabinets are insulated with foamed-in-place polyurethane insulation of 2" minimum thickness. Work tops are 2 1/2". Doors are mounted to cabinet on self-closing, cartridge style =' hinges with 1200 stay open feature. Door openings include low wattage, anti-condensate heaters. A plug-in type vinyl magnetic gasket is attached to each door for positive seal. WTF27 Convenient, contoured, pull handle is made of black ano- dized aluminum. Interior arrangement includes 2 steel wire epoxy coated shelves behind each door, adjustable in 1/2 inch increments. r-Nil� REFRIGERATION s� x '` Forced air refrigeration systems use capillary tube to meter refrigerant. Temperatures are held at zero and below. � Hti NO Refrigerant used is R404A. Automatic defrost is standard. gg Automatic (non-electric)condensate evaporator is provided. K ELECTRICAL r z a Units wired at factory and ready for connection to a 115/60/1 � phase, 15 amp dedicated outlet. 8' long cord and plug set included. WTF48 SPECIAL FEATURES 0 Cartridge style door hinges provides positive seal & ELECTRICAL CONNECTION eliminates door sagging issues (excludes glass door and Units pre-wired at factory and include 8' some special units). long cord and plug set. 0 6"casters, two with brakes standard. 0 Optional 6" legs or 3"casters available (i� 115/60/1 NEMA-5-15P *Note: Overall heights of casters may vary with different types of Available From: casters depending upon caster manufacturer designations. UL C UL US ® 8 =W 5� USA Model Specified Store# Location Quantity BEVERAGE-AIR Standard Worktop PLAN VIEWS Freezer Cabinets Models: WTF27A I WTF48A 24 1/4" MODEL WTF27A WTF48A DOOR WIDTH I_ L.—. 27"TOP 22 112" I(` EXTERNAL DIMENSIONAL DATA I _68 DOOR OPENING _ Length Overall(inches) 4 1 T Length Overall(mm) 686 129 II ---- -- --�— Depth Overall(inches)-Less handle 29 1/4" 29 1/4" 29" --- 27 1/16" —F Depth Overall(mm)-Less handle 743 743 TOP 23' CABINET _ INSIDE WIDTH _ 33 172" Height Overall—on 6"rasters(inches)' 39 1/2" 39 1/2" 1 29 1/2" 1 DOOR HT 21 t1/6" Height Overall--on 6"casters(mm)* 1003 1003 1 55 14" 1 DOOR OPENING Depth with Door Open 90= 53 314" 52 1/4" - ----- ---- — cL WIDTH 39 1/p^ Clear Door Opening(inches) 22 112"x 19 1/2"x STOP VIEW 23114° 21 1/2' ®®®®®® Number of doors 1 2 INTERNAL DIMENSIONAL DATA � FRONT VIEW NET Capacity(cubic ft.) 7.3 13.9 NET Capacity(Liters) 207 394 Internal Length Overall(inches) 23" 44" WTF27A Internal Length Overall(mm) 584 1118 Internal Depth Overall(inches) 25" 20" Internal Depth Overall(mm) 635 508 Internal Height Overall(inches) 23' 23" r_— 30 15/16" _ Internal Height Overall(mm) 5B4 584 Number of shelves 2 4 20" ELECTRICAL DATA INSIDE DEPTH Full Load Amperes 115/60/1 6.0 7.0 INSIDE HT ENERGY CONSUMPTION(KWH) 7.5 10.9 �� 4 REFRIGERATION DATA __......._..._._ _._..I Horsepower 1/4 1/3 WEIGHT DATA Gross Weight(Crated lbs) 166 246 LEFT SIDE VIEW Gross Weight(Crated kg) 75 112 *Note: Overall heights of casters may vary with different types of casters depending upon caster manufacturer designations. 5 44" @C U@ Us ® ® _ �^„�. WTF48A INSIDE WIDTH USA 19 1/2" 30 3/4" DOOR 20" �~ 48"OVERALL WIDTH ---IOPENING 21 1/2 INSIDE DEPTH DOOR OPENING 27"CABINET _— 29 3/9 3523 l4" 12"�291/Z 2 52 114" OVERALL DOOR HT INSIDE HT — -- I HT _ I 21 1/4" 1 DOOR WIDTH TOP VIEW FRONT VIEW SIDE VIEW BEVERAGE-AIR°CORPORATION 700 Buffington Road•PO Box 5932•Spartanburg,SC 29304 USA•(864)582-8111 •Fax(864)582-5083•(888)845-9800•www.beverage-air.com Specifications are subject to change without prior notice. 01/10 Item No. Quantity BF� r BEVERAGE-AIR ��►����� PO Box 5932, Spartanburg, SC 29304 WORK TOP MODELS: 1-888-845-9800 Fax# 1-864-582-5083 WTR27A http://www.Beverage-Air.com REFRIGERATORS WTR48A 29" BASE MODEL SERIES Commercial Refrigeration Equipment WTR60A General Specification WTR72A WTR SERIES WORKTOP UNITS t , Versatile, compact (29" deep) models with stainless steel work tops and refrigerated storage of food products. Working height is 35 1/2." gin, i Y CABINET CONSTRUCTION Heavy duty construction includes stainless steel on front, sides, door(s)and grille. Stainless steel 2 1/2"thick worktop with 4" high removable backsplash. Cabinet back and bottom are galvanized steel. Interior liner is made of anodized aluminum I for longer lasting corrosion protection. Interior thermometer is r standard. Cabinets are insulated with foamed-in-place polyurethane insu- WTR27 lation of 2" minimum thickness. Doors are mounted to cabinet on self-closing, cartridge style hinges with 1200 stay open fea- ture. A plug-in type vinyl magnetic gasket is attached to each door for positive seal. Convenient, contoured, pull handle is made of black anodized aluminum. Interior arrangement in- cludes 2 steel wire epoxy coated shelves behind each door, G` "`r adjustable in 1/2 inch increments. Interior light with manual ' switch is provided with glass door models. REFRIGERATION Refrigeration system utilizes R134a refrigerant metered by a capillary tube system. Automatic (non-electric) condensate WTR48 evaporator is standard. Interior forced air system,"with high humidity evaporator coils, provides the ideal environment for food preservation. ELECTRICAL ` Units wired at factory and ready for connection to a 115/60/1e phase, 15 amp dedicated outlet. 8' long cord and plug set in- cluded. SPECIAL FEATURES • Cartridge style door hinges provides positive seal & elimi- nates door sagging issues (excludes glass door and some �1- special units). WTR60 • 6"casters,two with brakes standard. • Optional 6" legs or 3"casters available ELECTRICAL CONNECTION Units pre-wired at • factory and include 8' *Note: Overall heights of casters may vary with different types of 115/60/1 long cord and plug casters depending upon caster manufacturer designations. I ' NEMA-5-15P �L C(Dusv a wm AWN Available From: USA 'Note: Not all markings may apply to all model variations. Model Specified Store# Location Quantity C*) BEVERAGE-AIR PLAN VIEWS Standard Worktop Refrigerator Cabinets 27" Models: WTR27A, WTR48A, WTR60A,WTR72A —`J WIDTH 22 112" MODEL WTR27A WTR48A WTR60A WTR72A DOOR OPENING H �_._.,.. 29114" - . I EXTERNAL DIMENSIONAL DATA Length Overall(inches) 27" 48" 60" 72" '--- - - -------- ------ - ` I Length Overall(mm) 686 1219 1524 1829 -' 20• INSIDE DEPTH .._...: 23-,. 2311L4-.... 33112:: Depth Overall(inches)-Lesshandle 291/4" 291/4" 291/4" 291/4" INSIDE HT 291f2" l.._"'- DOORH7 i 21 18' Depth Overall(mm)-Less handle 743 743 743 743 j ODOR OPENING ..- 39 1/2" --- I Height Overall—on 6"casters(inches)" 39 1/2" 39 1/2" 39 1/2" 39 1/2" ' Height Overall—on 6"casters(mm)* 1003 1003 1003 1003 __-._9_ I� Depth with Door Open 90° 55 1/4° 52 1/4" 53 13/16" 52 1/8" Clear Door Opening(inches) 22 1/2"x 19 112"x 22 1l2"x 191/2"x .. .:, -t—— --- 23 1/4' 21 1/2" 21 3/8" 21 1/2" FRONT VIEW Number of doors 1 2 2 3 COMMON END WTR27A INTERNAL DIMENSIONAL DATA NET Capacity(cubic ft.) 7.3 13.9 17.1 21.5 NET Capacity(Liters) 207 394 484 609 48" Internal Length Overall(inches) 23° 44" 56" 68" WIDTH _ Internal Length Overall(mm) 584 1118 1422 1727 19 1/2" Internal Depth Overall(inches) 20" 20" 24 7/8" 19 3/4" DOOR Internal Depth Overall(mm) 508 508 632 502 OPENING 21 1/2" Internal Height Overall(inches) 23" 23" 23" 22 3/4" DOOR OPENING Internal Height Overall(mm) 584 584 584 578 Number of shelves 2 4 4 6 ELECTRICAL DATA I 29 112" 23 7/4" Full Load Amperes 115/60/1 4.0 3.3 8.2 8.2 391/2" DOOR HT ENERGY CONSUMPTION(KWH) 2.88 2.37 3.76 3.38 OVERALL HT REFRIGERATION DATA Horsepower 1/6 115 1/4 1/4 FRONT VIEW WEIGHT DATA Gross Weight(Crated lbs) 161 235 265 305 Gross Weight(Crated kg) 73 1 107 120 1 138 WTR48A *Note: Overall heights of casters may vary with different types of casters depending upon caster manufacturer designations. & C&us V °�5A 72" USA 60" 19 1l2" D OR OPENI G � 22 1/2" 23 qia" 24 1/4" DOOR OPENING 39 /2" 29 1/2 DOOR 29 1/2" DOOR WIDTH WIDTH OVERALLHT [JE - 1 1 39 112° HT , L wmiiIiiiiimmm= J. l FRONT VIEW J DOOR OPENING FRONT VIEW WTR72A WTR60A BEVERAGE-AIR®CORPORATION 700 Buffington Road•PO Box 5932•Spartanburg,SC 29304 USA•(864)582-8111 •Fax(864)582-5083•(888)845-9800•www.beverage-air.com Specifications are subject to change without prior notice. 01/10 :.-...no.:a;;.a•�,�w�i�•.G�..u:.�;r. .rxws.,,.x• �:s.. .tee �., � MIN n �0, » 3 9 v- tl ,'yy��d.`w,u�a''- _ _ '�� 1 � 4..._.. r� s..S rt � � .�k�:'�* � •l r�. aN,'?�` �� � i �w#; F�.""i; FD',INodel�r�. 3-:5u I Ser4efi-'`(w r 'seyi<Slarve ;; 1`IISe`ry ,�.2t ioi z �� `W iura�a�xeurtaw'aa.�.wz.zv�ur'.�4, s2ha .; 2 "•:i alale:Mtetat3heltre"sue- 4• __ lfolurY�g', 6 6 rr .. 6 ub (f 3 blc h 3 c.bx R t .`, ... auk• .nw.� a y ' Xenon 120V(6) Xenon 120V(6)1 Xenon 120V(3) Xenon 120V(3)''' -.i s � ¢ �'kPlates '� "' ..r�¢• .,..:'*f� 3. `wgi ;.'-.�,aEr.w" 2 .,a° :: i M. 41 g • 9' & nd+o'Shs}elv - .1 W(4). ..?� r "' « I 141 W(4) 141 W(2) 141 W(2) _ ? 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'�.�»",'� '�w�.�°� k :n.,�, b fur�-��et,T� "�'n �,e;ns,,,.°'^,� �•r�t4�t� o " q <�*�'�,�+' 0 a • I • + tiY +kh+Y'� ss �h fix+ YFa� ki C w i Q r5. O 5 O LA ed Mix&Match Set-upNA • Available! • �= "� `' fix' , ��`x���� i • � W �� z s �.P �c c�� oa �i'm�vma���,���`"€ ������. � - �� �� ti's. 4 .�"i--�,ja•,. �s ,.�l�m.e� ,r ss��� e � �,,.r��'x`r° 3��. � ,� �.lsS� �. r tt s z s •. a c Kari-Pak CDG�x21�11S rii 4 s bL �,U` { is e z seJ, A, 1 F "+, $ S O f t "nt YF` f 1 .` C t CDG Series li u d dis ensers�areikcost-effective refrigef fredN,i uid dis w ensejr? r ° •. pox{ to zp. '5 a{ a �z`vim .�.lt"� ry 4 iC #C✓I'+rx� { systems capable of dispensing up totwo different bag`irl box products RrT', �. V� y`c r� 6 t 17 =Features • Sunple product dispensing for various liquid jproducts uicluding'milk,cream,'cold coffee;` juices and many mores • Manual,lever operated dispensing system p YNA : ,` d'� )E ensures maxunum; up tune with " M no in.icroprocessor'issues _ � ��, �' ERA _ •,Holds two 95 Litre/2 5 Gallonkbag in box , . } Produc' ' r forefrgerated'cis erismg >r „ -:Best value on the market.'delivcruig the fastest "y return on uvestriient and ma ximurn,profitabihty • Simple install and easy to use to remove Y w from carton and power the unit up x + > ; Y m 00�. r t * that's all there is'to lt� s{ i U= :- r a? SpeC-.icaions • Dispenses two products.Manual,lever;operated • Capacity:. 2.x 9.5 Li re x 2 5'Gals •Wei t 771bs •Duriensions 22"x 12"x 25 1/2"(L x W x i 4 •A/C Supplyvoltage 120VAC/60Hz/lA/4Amp {`•pRefrigera"tion Compressor cold wall evaporation; �� accurate to 32 F/0 C •Environmentally friendly 134A refrigerantoCFC free s.•."n M ✓ ,,�$j r �yy' ,ry;' #r, i t s x' d +,' i # 1 a;y I-sr '+ '} ati::a 4Y r� ' s ",a n St�ainle_`ss steel eonstrucQo-n witl �polyuret..n e insulation rt1 asg Shipping D ensigns M�wC,^ avfi i at�`r ba `'!r� ,gry a Ar ' t s �- kx fr h yx hipp:� g Wegh �841 y s. a rwx Yk , , �,� rile rill xa J ma r s �vc p • :CIDG 2llis certified by1�1SFto both the .' ,s ; �� kKg " s SF/A1�1SdI,IRON., dard2x�ti V Il/AN S YcCanadia�xand _ 53 lH7`tt 4H '�:tF^6 vy d YT f u��T.�� es :eats: � °'`,q�"�4@-`�,'`� � +y �+*�sn �,�'s+�i •I"•�� �' { f+� 'r.�r•a « � _ $ .; Tit •y• "�3 ,>''r'z:� � i1` r ri c �' kyt " +o-,% h p1,4 r^1Y x e a v a'{ts M1X f y i.�. C z _ .xj t' _ n. y r r Y v i-a�s ��. --r,ase: o t c � � ,.�� � � <� € F�ti] • ,. S t� � nz .x x6��r Ppr,...«1 �Ty y� � it �� gLs x€tap�'l� � y., _ •�,.,;�'��,r`a � � 'bhp ���. �� � � wC' �^ ^.'der ,rt�° 5"R F'��leaseyvi�stits one the web apt n pak c�om'� j � �` '� F i S .- `sw�•,��� �-;`.iyri-�'�" :tea°�4rn�� ,w°'eh' ;.i° to * ..+: 7 -. b Y .,�4�t ., . � ...,�..�,.. .. .�..... .•....... � go-.v. i n�.A^,I;,. 4 Y F �. y 3 4 f • ' l I I I BUNN® ITEM# Silver Series® 2-Flavor PROJECT Cold Beverage System DATE Features 19"it, u � S Cold Beverage System • , }} } Cold beverage dispenser with patented High Intensity®mixing delivers 1 superior drinks consistently glass after glass ;. k • A cost effective solution to providing your customers with superior performance in juice and other concentrated beverage dispensing. r; 'ry `'" • One dispenser delivers both frozen and ambient products increasing profits by lowering costs. • Drink consistency assured with the BUNN patented High IntensityTM mixing technology. • Pumps and mixes 2+1 to 11+1 concentrated beverages, including 4+1 high viscosity and 5+1 juices accurately and consistently. • Quick dispense with 1.0 to 1.5 ounces (29.6 to 44.4 ml) per second flow rate. • 7"cup clearance accommodates most juice containers. • 8 lb. (3.6 kg) ice bank provides superior cold drink capacity. • Advanced concentrate pump designed for easy setup, accuracy and durability. • Modular dispense deck makes service fast and simple. • Both push-button and single-size portion control in the same machine. Model JDF-2S • Available with Iced Coffee or Juice display. (available with juice or iced coffee display) . Preventive maintenance kit:39690.0000. Dimensions:33.1"H x 10"W x 25.5"D IPINKI (84.1 cm H x 24.9 cm W x 64.8 cm D) For current specification sheets and other information,go to www.bunn.com. • 3 ' rx y , n s �� .°..,,. .. Easy Clear®EQHP-10 Ambient Conversion Kit ,L Product No.:39000.0004 Product No.:33699.0001 , (one kit required per dispense 1 station-photo shows 4-dispense station unit with Easy Clear'EQHP-10CRTG � P Product No.:39000.1004 l4 one container and three ambient conversion kits) Refillable Juice Container ` Capacity:1 Gallon �a Product No.:39302.0000 �f Model Agency Listing JDF 2S ,. .6 r - Dimensions & Speaf►cat►ons � l Cubic Shipping Cord Model Product# Volts Amps Capacity Measure Weight Attached JDF-2S 37900.0000 120 4.6 4 (5 oz.)drinks/min* 10:3 ft3 1'MAbs JDF-2S" 37900.0001 120 4.5 4 (5 oz.) drinks/min* 10.3 W 103 lbs. Yest JIDF-2S 379010.0002 120 4..5, 4 (5 oz,)drinks/min* 10:3 ft3, 1031bs. Pest':; (iced coffee display) JDF-2S 37900.0025 120 4.5 4 (5 oz.) drinks/min* 10.3 W 103 lbs. Yest (dual dispense-allows simultaneous dispense from both dispense heads,juice display) Refillable Juice Container Product No.:39302.0000 Capacity:1 Gallon 75T(24°C)incoming water for 180 drinks without exceeding 41 T(5°C)finished drink temperature. Model includes air filter rPower cord(NEMA 5-15P) 15 Amp-120V machine only. Electrical: Model requires 2-wire grounded service rated 120V, single phase, 60 Hz. Plumbing: 20-100 psi (138 -690 kPa). Machine supplied with %" (0.95 cm) male fitting. Refrigeration: R-134a refrigerant, 9 oz. (.28 kg), 8 lb.(3.6 kg) ice bank system 12.ao s. s m m go 5.0 �10.5 21.90 0o m oo m e e co 00 FLAVOR LABEL HOLDERS JUICE DISPENSE ^^ 33.06 SWITCHES REFRIGERATION ON/OFF SWITCH WATER IN 7. 0 .375 MALE FLARE m m e e �MS AD. 7', \\\ f�-75� 7.25� 120V POWER CORD Bunn-O-Mati&Corporation-1400 Stevenson Drive Springfield,Illinois 62703.800-637-8606.217-529-6601 •Fax 217-529-6644•www.bunn.com BUNN®practices continuous product research and improvement.We reserve the right to change specifications and product design without notice.Such revisions do not entitle the buyer to corresponding changes,improvements,additions or replacements for previously purchased equipment. All dimensions shown in inches. 51100 Bunn-o-Matic corporation Ice-0-Matir ICE1506 - Cube Ice Maker Features Space saving 22"(558 mm)tall design. r Produces up to 1,432 Ibs(650 kg)of ice per day. a Harvest Assist provides consistent ice production for the life of the ice maker while reducing energy consumption and increasing capacity. Pure Ice®exclusively by Ice-O-Matic.Built-in antimicrobial protection • for the life of the ice maker inhibits bacteria growth on ice maker surfaces.Ice-O-Matic's optional water filtration system provides protection against unpleasant tastes,odors and scale formation. K - Durable,electroless nickel plating on all evaporator plates ensures reliability. Longest warranty in the industry.Purchase an Ice-O-Matic water filter with your ra f cube ice maker,replace the filter every six months,and the evaporator warranty is extended to 7 years parts and labor(available in the U.S.and Canada only). Constructed from corrosion-resistant stainless steel. ICE1506 on a dispenser Note:The ICE1506 comes equipped with a Bin Thermostat kit Options&Accessories Ice Maker Warranty Every Ice-O-Matic ice maker is backed by a warranty that provides Water Filters both parts and labor coverage. r - ' # Three years Parts and Labor. Ice.Machlne,w__... __�.___ § d __ µlb Inane ry Five years Parts coverage on the evaporator and compressor. I Model i. System, { Replacement T System ! Seven years Parts and Labor on the evaporator when you purchase an Ice-O-Matic water filter with your cube ice maker ICE1506 IFQ2 IOMQ(2) N/A _._..W__._._......_..0_�..._. ._..._..... _..____......._. .. .___.._.-.-__..__ and replace the filter every six months(available in the U.S.and Canada only). Ice Form 1506 is used with dispensers only V Wrr �Wx DxH(In) trt bx?hx,b i KBT25030 } KBT25030 1 W.x D x H(mm)k 22 x 22 x 22 ; -___-- I_.__. .._.._.............r...,__.,.._.......,. ....-__.....,......._.. ......_,....�......-,_._"__---_........ ,..........._"r......._.�...�.,�..-,_._.....1 rWxDx H--- _ W zDxA(mm)'22z 22x 10 cQ L)us NSA lsa �` M ,...1 . LAD --- 4,r :1 11100 E.45th Avenue Phone: 1.866.PURE.ICE Rev: A-02/09 Denver,CO 80239 Fax: 303.371.6296 Part: 1019 www.iceomatic.com ice-0-Matic Top View 4.5" (114 mm) • H. K ® Remote Cooled E.,., A.Ice maker potable water in,1/8'FPT. D• 4i`� ', B.Ice maker water out,1/4"FPT. ® C.Hole for electrical connections,/8'. \ry F+s G i D.Ice maker water out,1/4'FPT (optional). O E.Ice maker potable water in,1/8"FPT 11.66"(257 mm),- z.os'(s1 mm) 16.14"(332 mm)° _--.._._ _ _'.__ I --- 1.1"(28 mm) (optional). E F. Liquid line,3/8'male quick connect 22.13"(561 mm) - ---- coupling for precharged line set (remote only). G.Discharge line,''/2'male quick connect Back View coupling for precharged line set. H.Ice cube dispense area in bottom of unit. ® ® ® ® 2.22"(56 mm) 5.12"(130 mm) 20 (508 mm) �, Ice Maker mounting holes -._. _.... . . ........ (underside)' 1916'(487 mm) Operating Requirements Dimensions AmbientTemp Range Air i 50F(tOC) r_. 100F(38C) j WxDxH(mches) s 30x285x22 Water Temp 40 F(4 4 Q 100 F(38 Q W x D x H(mm) 762 x 724 x 558 Water Pressure i 20 PSIG(1.4 BAR) 60 PSIG(4.1 BAR) ! Specifications of . . •e, e - e •e e' e •e' T tt ( ICE7506HR* i Remote -1 1432(650) i 1216(553) 19 5 4 6 1I 20&230/60/1 ( 24.5 30 22,491 *Requires Remote VRC2661 Condenser NOTES: Number of Wires: 3(including ground) Approx.Shipping Weight Ibs(kg): 300(136)w an *ENERGY STAR qualified machine.Please see our website www.iceomatic.com for the latest list of ENERGY STAR qualified machines and available rebates. 11100 E.45th Avenue Phone: 1.866.PURE.ICE Rev: A-02/09 Denver,CO 80239 Fax: 303.371.6296 Part: 1019 www.iceomatic.com LOCER, FLAVOR 6 I - 6 SELECT - FS30 f ' '� 8ttx�o'�7atrara"�'. �Rofl Flavor Select Advanced Ice-Beverage Dispenser t The FS30 offers over 112 unique flavor combinations. Self-serve dispensing is interactive and entertaining with eye-catching "Lite TouchTM" buttons. State-of-the-art cold 4 carbonation technology provides a consistently pleasing drink experience for our customers. i s Cold carbonation for consistently a Fits in current 30" IBD footprint = better drink quality }! - "Air MixTM" nozzles blend 16 Brands for over 112 syrup and water in midair for Flavor Possibilities consistent drink delivery Add up to 12 bonus flavors Illuminated easily I to create an exceptional interchangeable merchandiser drink experience Large capacity removable I _ "Lite TouchTM" brand light show drip tray and cup rest I draws attention to your more I p Cubelet ice capable dispense profitable fountain section! is available-specifications { Self-contained with on request multiple ice fill options �OR ETL CERTIFIED TO UL STD 763 AND CANICSA STD 22.2 NO,195 I I 6655 Lancer Blvd,San Antonio,TX 78219 210-310-7000® 1-800-729-1500- FAX 210-310-7250°vwwv.lancbrcorp.com i i t i LA)VCER, FS30 1 1 1 S P E C I F I C A T I O N S 26 142 Mm 3r (762 mm) i 40i)4' 145V, 0022 mtnf (372 nim) with(ld 1 �%. ;• I � I i j 4.1 1= 1 r (114 mm) 13116' I l 1 981 (mpi li wNhoulild t � I � I (254 mint �. �— 23, ,a User Interface Options for FS Series ►r -- ,.� (sBa m r t ..►' 301t2`�� n FS30-16 Brands,112 Flavor Possibilities ( - 1 11e°'m'"); FS30-14 Brands,98 Flavor Possibilities FS30-12 Brands,84 Flavor Possibilities } FS30-10 Brands,70 Flavor Possibilities FS30-8 Brands,56 Flavor Possibilities , Ir fF t Wldtfk 30(Fl(1(2= 1mJ� 1151(ACI60Hz 7AM1 ScFd t 11 is y , e 11 Al r - Lancer"Lite Touch"user interface Panels , .. SPACE REQUIRED; xWith�tce;620(bs(2 1fkg�� F lie>ed water 50�ps1tmin �L'e �td'� 9`r1°G425�mm1� Sl'PRttt 356IUs(1&I�k U to 16 enhanced Bonus Add u to 12 Up to Flavor bonusNavor .•�ToP'61n mm) �, �F Capacity � available indicator options xt ' " '�z 1 �' i'"ate'' ' �'� '`4 �' � x ->,Optl�r1 �,�.,0 '2�;�'� Ds��� �� � � Lancer LFCV Valves Front connection for products I Key lock switch for valves Access to floor drain suggested Field Configurable Parts warranty s f Warranty:For warranty specifics by product, j CORPORATE OFFICE 6655 Lancer Blvd-San Antonio,TX 78219 contact your Lancer Sales Representatives. 210-310-7000.1-800-729-1500-FAX 210-310-7250�www.lancercorp.com Equipment design and/or specifications may change without notice. "Lancer'is the registered trademark of Lancer Corporation-©2010 Lancer,all rights reserved. FS30 Spec Sheet 01/10 !t t , 1 1 • f Item No. Quantity 1% y BEVERAGE-AIR 'M S, - ..�►.)�L� PO Box 5932, Spartanburg, SC 29304 BOTTOM MOUNTED MODELS: 1-888-845-9800 Fax# 1-864-582-5083 KF24-1AS http://www.Beverage-Air.com REACH-IN FREEZERS K SERIES KF48-1AS Commercial Refrigeration Equipment SOLID DOORS KF74-5AS General Specification CABINET CONSTRUCTION Heavy-duty construction includes stainless front (doors and grilles). Exterior sides are steel with gray finish. Exterior top and back are galvanized steel. Interior bottom is stainless. a �t Interior of cabinet is constructed of white coated steel walls. Adjust- i able epoxy coated steel wire shelves are standard(3 per section). p1 Foamed-in-place CFC and HCFC-free polyurethane insulation enhances the structural strength of the cabinet and helps increase "`- energy efficiency. h -- A`�✓4 Doors attach to cabinet on cam-lift hinges. Hinges permit doors to stayopen at 120' and gravity self-close. Snap-in magnetic gaskets P 9 Y P 9 9 for a positive seal are standard. Gaskets are easily removable for cleaning. Three-inch heavy-duty casters included, two with brakes ON standard. lam ,„ .,r ) A E REFRIGERATION Balanced refrigeration system is located at bottom of cabinet. System uses R404A refrigerant, which is CFC and HCFC-free for Ha compliance with environmental safety concerns. Defrosting is `®°"pi KF48-1AS accomplished with electronic heaters. Defrost is time initiated, tem- perature terminated. A time termination is provided as a back up KF24-1AS fail-safe. Evaporator fans are delayed from restarting until evapora- tor coil is adequately chilled down. Operation of compressor is gov- erned by temperature control inside top of cabinet. , Enhanced digital control is located outside top of cabinet. Controls—` °; _ includes "Door Open Indicator" and displays internal cabinet tem- perature. Internal cabinet temperature is fully adjustable using the F t digital control. :% " t SPECIAL FEATURES • KF74 model has earned the ENERGY STAR®. % "� " y $+o ' " • Enhanced digital control adds function x N � • Stainless steel front(grilles and doors) _r,.M:_. _,. KF74-5AS DIGITAL CONTROL s Available From: c U` us PISF �w��,�. USA 'Note: Not all markings may apply to all model variations. Model Specified Store# Location Quantity a BEVERAGE-AIR PLAN VIEWS Bottom Mount, K Series Freezers 27" Models: KF24-1AS, KF48-1AS, KF74-5AS MODEL KF24-1IAS KF48.1AS KF74-SAS EXTERNAL DIMENSIONAL DATA Length Overall(inches) 27" 54" 82" Length Overall(mm) 686 1372 2083 52" Depth Overall—(inches)less handle 30" 30" 30" 78.1 INSIDE 78" o Depth Overall—(mm)less handle 762 762 762 HT _ Height Overall—(inches)less casters 78" 78" 78" Height Overall—(mm)less casters 1981 1981 1981 Number of doors 1 2 3 Depth with Door Open 90° 56" 56" 56" INTERNAL DIMENSIONAL DATA O O NET Capacity(cubic ft.) 23 49 72 NET Capacity(Liters) 651 1388 2039 ----- Internal Length Overall(inches) 23" 50 1/2" 78" I.,_ 30" _,.I KF24-1AS Internal Length Overall(mm) 584 1283 1981 Internal Depth Overall(inches) 26" 26" 26" END Depth Overall(mm) 660 660 660 Internal Height Overall(inches) 52" 52"• 52" Internal Height Overall(mm) 1321 1321 1321 Number of shelves 3 6 9 ELECTRICAL DATA Voltage 115/60/1 115/60/1 208-230/1/60 Amps 8.7 10.5 10.5 REFRIGERATION DATA 78" o o Horsepower 1/2 3/4 1 WEIGHT DATA Gross Weight(Crated lbs) 323 503 698 0 0 Gross Weight(Crated kg) 147 228 317 0 0 o O 5 FRONT @ c&us NSF �,�A� KF48-1 AS USA 'Note: Not all markings may apply to all model variations. 82" ELECTRICAL CONNECTION 0 0 D 0 115/60/1 78 1 ' NEMA-5-15P 4-wire plug NEMA L14-20P 3-wire plug O O O O O 0 O O O KF74-1 AS BEVERAGE-AIR°CORPORATION 700 Buffington Road•PO Box 5932-Spartanburg,SC 29304 USA-(864)582-8111 -Fax(864)582-5083-(888)845-9800-www.beverage-air.com Specifications are subject to change without prior notice. 01/10 RMZC30 SPECIFICATION SHEET 153 3/8 5 DOOR W/O ENDS 122 15/16 4 DOOR W/O ENDS 92 1/2 3 DOOR W/O ENDS ALTERNATE 62 1/16 REFRIGERATION 2 DOOR W/O ENDS TOP EXIT4 9/16 2 1/2 \ \ \ \\ \ 3/4 2 TOTAL HEIGHT INCLUDING TRIM RMZC30 6 5/8 '(5 5/8) Front View 16 �— 4 3/8 4 REFRIGERATION L�74 3/4 1" DRAIN CAN BE ACCESS HOLESR SAES EGRESS FROM 2 3/4 INSTALLED OPPOSITE BOTTOM BACK 27 1/4" /4" ELEC BOX AND FRONT * USES 3 1/2" BASE * NOTE: CASE DIMENSIONS SHOWN REFLECT STANDARD 4-1/2"HIGH BASES 37 1/8 DIMENSIONS SHOWN IN(PARENTHESIS) REFLECT 3-1/2"BASES. ALTERNATE 3 3/4 REFRIGERATION EXIT OUT REFRIGERATION TOP BACK EGRESS LEFT BOTTOM BACK Bea 10 1/8 5 3/16 / L 4 1/2" HIGH 64 1/8 t!� R3E 1 2 BASES SHOWN 64 3/4 INTERNAL 82 3/8 3RIGERATION EGRESS BOTTOM FRONT HEIGHT CASE 1 HEGBHTS 1 1/234 --� WITH TOP AND ELECTRICAL ACCESS HOLE AND DRAIN END TRIM REMOVED TO FIT THROUGH DOORS Partial Side View (Bottom) 15 1/4 8 ° Side View Zero Zone, Inc. . 110 N. Oakridge Dr. North Prairie, WI 53153-9792 1-800-247-4496 . FAX: 262-392-6450 www.zero-zone.com J All specifications are subject to change without notice. RMZC30 RMZC30 SPECIFICATION SHEET REFRIGERANT CONNECTIONS REFRIGERANT CONNECTIONS SIZES FOR ELECTRIC DEFROST SIZES FOR HOT GAS DEFROST SUCTION SUCTION MODEL SUCTION LIQUID LINE O.D. FOR MODEL SUCTION LIQUID LINE O.D. FOR NUMBER LINE O.D. LINE O.D. REFRIGERATION NUMBER LINE O.D. LINE O.D. REFRIGERATION OUT TOP BACK OUT TOP BACK 2RMZC30 7/8 3/8 5/8 2RMZC30 7/8 1/2 5/8 3RMZC30 7/8 3/8 5/8 3RMZC30 7/8 1/2 5/8 4RMZC30 7/8 3/8 7/8 4RMZC30 7/8 1/2 7/8 5RMZC30 7/8 3/8 7/8 5RMZC30 7/8 1/2 7/8 ELECTRICAL SPECIFICATIONS BY DOOR MANUFACTURER CAPACITY T-10 T-10 SPECIFICATIONS ANTHONY DEFROST MODEL FANS T--8 LIGHT LIGHT ELM STANDARD HEATER USABLE VERTICAL LIGHTS AMPS AMPS ANTI-SWEAT MODEL CUBIC SURFACE NUMBER AMPS ANTI-SWEAT AMPS NUMBER FEET SQUARE AMPS ONE BOTH HEATERS HEATERS 208V/1/60HZ. END END FOOTAGE 2RMZC30 51 28 ANTHONY DOORS 3RMZC30 76 41 2RMZC30 0.68 1.45 1.50 2.25 2.23 4.42 6.73 4RMZC30 100 55 3RMZC30 1.02 1.94 2.25 3.00 3.12 6.44 10.09 5RMZC30 125 68 4RMZC30 1.36 2.42 3.00 3.75 4.05 8.32 13.46 CASE WEIGHT 5RMZC30 1.70 2.91 3.75 4.50 4.94 9.80 16.83 SIZE IN POUNDS* ARDCO DOORS 2RMZC30 792 2RMZC30 0.68 1.89 1.50 2.25 N/A 5.52 6.73 3RMZC30 1,102 3RMZC30 1.02 2.34 2.25 3.00 N/A 7.83 10.09 4RMZC30 1,476 4RMZC30 1.36 3.06 3.00 3.75 N/A 9.84 13.46 5RMZC30 1,880 5RMZC30 1.70 3.51 3.75 4.50 N/A 12.05 16.83 *WEIGHT BASED ON SUBTRACT 0.19 AMPS PER DOOR FOR PSC FAN MOTORS UNCRATED CASES WITHOUT *STANDARD FOR CASE IN A LINE-UP ENDS, AND FULLY SHELVED. VOLTAGE: 115 VOLTS 1 PHASE 60 HZ. ISINGLE END WEIGHT: 54 LBS. BTU/HR ENERGY REQUIREMENTS: FROZEN FOOD -11°F EVAPORATOR (-5°F AVERAGE PRODUCT TEMPERATURE) ICE CREAM -18OF EVAPORATOR -12°F AVERAGE PRODUCT TEMPERATURE MODEL BTU/HR @ BTU/HR @ BTU/HR RATING BASED ON T-8 LIGHTING&PARALLEL RACK SYSTEM. NUMBER -110F -18OF MULTIPLYBY 1.04 FOR CONVENTIONAL SYSTEM. 2RMZC30 3,140 3,390 ADD 30 BTU/HR PER DOOR FOR T-10 LIGHTING 3RMZC30 4,540 4,920 DEDUCT 57 BTU/HR/DOOR FOR PSC FAN MOTORS 4RMZC30 5,890 6,390 CASE DESIGNED TO OPERATE IN AN AMBIENT 5RMZC30 7,340 7,970 OF 750F OR LOWER AND RELATIV E RMZC30 FOR ELM AT-110F FOR ELM AT-18OF HUMIDITY OF 55%OR LOWER. W/OPTIONAL DEDUCT250 DEDUCT295 ELM DOORS BTU/HR/DOOR BTU/HR/DOOR Zero Zone, Inc. . 110 N. Oakridge Dr. North Prairie, WI 53153-9792 OL C�L 1-800-247-4496 . FAX: 262-392-6450 WWW.Z@r0-ZOne.COC71 All specifications are subject to change without notice. - RMZC30 Wa FROZEN .- BEVER A GE '?tYa'� :+.E'"���$Y t^ •"y^s+' y�',. Y- '' f5�v Y �t`k�' } DISPENSERS SPECIFICATIONSFBD 562 ?. DIMENSIONS " FBD D000Opttons&Features 2 Barrel Dispenser bOt�0 1 a Countertop unit assho+nmonFB;D�564 Width: 17 in (432 mm) Depth: 32.38 in (822 mm) FBD Door Options Height: 41.4 in (1052 mm) III%�0 jU C E (with merchandiser door) //�� ENE PR ROZEN s } 3 Countertop unit on base cart Width: 17 in (432 mm) Depth: 32.38 in (822 mm) if Height: 75.4 in (1915 mm) �} titer 4 . r 1 (with merchandiser door) + s ` ELECTRICAL REQUIREMENTS Short Door 215 to 245VAC,single 4 phase; 3 wire, 20 amp; uses NEMA #L-620-R receptacle Refrigeration Unit: 19,000 BTU/Hr, R-404A 50Hz `� x >y, 15,000 BTU/Hr, R-404A(60Hz) SPACE REQUIREMENTS ! Sides or Back: 2 in (51 mm) min Top: 12 in (305 mm) MINOR £� s n WEIGHT `r �— Operating unit: 345 lb (156.5 kg) Tall Door,Front Lift Base cabinet:80 lb(36.3 kg) Tall Door ; SYRUP CONNECTION Bag-In-Box(BIB) ,. Qof , 472mm\ r MOTORS gant(I>(241HPHp ror//'sue WATER REQUIREMENTS Fresh water,30 PSI min 41.4" OS2mm Side Open Door DRAW PERFORMANCE a „�.nm Available in Short 75'F(25'C) Ambient a ! R or Tall Version 45% Relative Humidity ! FBD Features 64oz./minute continuous p { alternating barrels 75.4' Y issmm' �/ • OPTIONAL ACCESSORIES Base Cabinet w/Casters(Part#12-2493-0001) Leg Kit(set of four) (Part#12-2533-0001) off—ve �E�V) v� Water-Cooled Unit Equipment design and/or specifications may change without notice. also available FBD•8161 Interchange Parkway,Suite 115•San Antonio,TX 78218•210.637.2800• 1.866-323.2777•Fax:210.637.2832•www.fbdfrozen.com 05/08 Copyright©2008 by FBD Partnership,LP,All Rights Reserved. 24-2314-0001 G Js'JS ° EK..•riHF..kJf... '°"'• _ +knM -r aY �r - ;FRpZ=EN � y' � � '# i Y•�T :�� �•:��vG`•J3 {T { 6 �i'-1 � + s���f'e# ..,_ ��':�kY y.: ." � ' . 5 �d�.*A 7-FAIN WNMLk�_�19 �X �SE�LF SE�R�VE TM W- Accomodates 2 barrel (550D) or 3 barrel (553D) dispensers • Space for 3: 5-gallon Bag-in-Box Syrups„ Dome Lid and Straw Dispenser . . • 15-gallon waste tank for drip tray • Space for 1: 20-lb. CO2 tank • Valve Locks available • Water Required: 3/8" water line, 25psi min. pressure • Electrical Required: 215v to 240 vac, single s. phase, 3 wire, 30 amp , y, • Easy to install . ' SELF-SERVE CART 12-2712-0001 Self Serve "Unplumbed" 550, 553 12-2712-0002 Self Serve "Plumbed" 550 _ 12-2712-0003 Self Serve "Plumbed" 553 # ' LOCK KITS Reduce Shrinkage ' 12-2668-0001 Kit, DDV Barrel Lock (550) 12-2668-0003 Kit, DDV Barrel Lock (553) , 3 F t Sy MOUNT CHECK OUT REGISTER SIDE M 0 �+ Model 553D Shown on CUP DISPENSER z 42-2031-0001 Side Mount Cup Dispenser 553 Self Serve Cart (Holds cups up to 44oz.) t� ' ''r`'°" -..;X'x" "'',fi=_,`. '.g'xw3'x'"+•r,eF+Rb"Y•!s' G'J•s.3.-�g,< ' s •.'.w''rsr�A ., T...,`",sy'""i 'at- -nz. .a�siFr' +: "4"""h'ECF`P7s*"�s"_0 ,,i '' f 3n"r a"y`• sw. r ' SPECIFICATIO'N�SSE'LF SER�ECART4;. ., " . `t ,, RAN � DIMENSIONS Width: 33.1 in (841 mm) Depth: 31 in (787.mm) Height: 46.5 in (1181 mm) 1 --`-`—33 t" — 310 u -20.5 n l 46;5 i � 30.5 n I n E 0' i� Equipment design and/or specifications may change without notice. LANCER FBD 5620 Business Park Dr.•San Antonio,TX 78218•210-666-0544.1-866-323-2777•FAX 210-666-2044•www.lancerfbd.com Copyright-2005 by Lancer FED,all rights reserved. 38-FBD-SELF-SERVE CART 2/05 24-2194-0009 lj�W11s r - - -...' F y�T y�'"•Fgw �' 'i' -•__ F n -A 4 i c ACCESSORIES � f. y � ,rt r t y 4 '�' +a'2w'�Y *5.• tl°} 11 '.) �j t '� 3�At� � 8 ,�`. � INSTALL KIT • All Models Available • Great for multi-unit placements ��wr r'«� 54. • All essential parts needed to install FBD • Necessary tubing, fittings, regulator(s), install diagram • BIB racks available ' 12-2474-0001 Install Kit, 2BBL DOM (550) BOTTLE CO2 SYS.12-2474-0002 Install Kit,2BBL DOM (550) BULK CO2 SYS. ` ®. 3 12-2474-0004 Install Kit, 4BBI_DOM (554) BOTTLE CO2 SYS. 12-2474-0005 Install Kit,4BBL DOM (554) BULK CO2 SYS. 12-2474-0006 Install Kit, 3BBL DOM (553) BOTTLE CO2 SYS. 12-2474-0007 Install Kit, 3BBL DOM (553) BULK CO2 SYS. " BUCK Et BOOST • Requires 215 voltage range input; required so compressor operates properly -- • Prevents voltage gaps when voltage is not within specified voltage range • Allows voltage to maintain 215 to 245 VAC rangeZi _ • Correct electrical is critical • Prolongs life of electrical motors ; 14-0378-0001 Buck'N Boost Transformers (Models 550 and 553) 6.2"h x 6.2"w x 4.7 d 14-2089-0001 Buck'N Boost Transformers 1.OKVA (Model 554) 8.3"hx6.94"wx4.91"d �.-.. E CUP/LID/STRAW DISPENSER an , • Maximize counter space with ; .' compact modular cup/lid/straw dispenser r • Easy to clean and maintain • Holds cups up to 44 oz. ,. 42-2030-0001 Self-Service Cup/Lid/Straw Dispenser 33.5"h x 8"w x 21.75"d 42-2031-0001 Side Mount Cup Dispenser Equipment design and/or specifications may change without notice. LANCER FBD 5620 Business Park Dr.•San Antonio,TX 78218.210-666-0544.1-866-323-2777•FAX 210 666 2044•www.lancerfbd.com Copyright 2005 by Lancer FBD all rights reserved .,,rr:.r,�'P'"> •�-u, .•-r�Y,.;,+.�sr av �;...cam .�„�a. Nr+' �ry a �':. a�, +' c t<�`� ;�r �a� f 3�si'cx""+i'z`�+t�"�',r;Maxn'4'�F''c �z� �%�-ya�r,x'er�r� y +'�"n"�. 24-2194-0013 s o & JAMES MORETTI E RESIDENTIAL Q LEGEND W 50 SUOMI RD. 9 MONITORING WELL E M MW-10 PROPERTY BOUNDARY `r' DAVIDSOMERO ® CATCHBASIN RESIDENTIAL UTILITY POLE N c 34 SUOMI RD. ® SOIL BORING B-1 ADVANCED ON 1.0/31/00 BY ECS. o SHADY LANE • SOIL BORINGS BMW-4 AND BMW-7 0 ADVANCED ON 04/18/02. w W WATER LINE O DAVID SOMERO =.SS— SANITARY SEWER LINE a VACANT WAYNE ZERRIS 30 SUOMI RD. RESIDENTIAL 67 SHADY LANE —GAS— NATURAL GAS 0 LISTS UNDERGROUND STORAGE TANKS Q CARL E.MUELER O ♦ POST EXCAVATION SOIL SAMPLING LOCATIONS RESIDENTIAL WAYNE ZERRIS ON 10/15/98 AND 10/21/98 22 SUOMI RD. _ VACANT RESIDENCE 65 SHADY LANE c> =o 0 rn � THOEDORE HYORA w RESIDENTIAL C MBERLA D U MW-11 18-20 SUOMI RD. MW- FARMS REGIONALVACANT VACANT WEST MAIN AUTO O OFFICE GS-2 NW SIDEWALL BASE EAST (FOOT D) (FOOT D) S ALFRED AND GENERAL NOTES: GS-3 LEAH ZERRIS SITE PLAN PREPARED FROM A TOWN OF HYANNIS ASSESSORS MAP, rn CB USTs i; 405 WEST MAIN SITE PLAN BY ECS,AND SITE RECONNASSAINCE BY ENSR.ALL LOCATIONS,DIMENSIONS,AND PROPERTY LINES DEPICTED ON THIS 379 W.Main St. 51) CAN Y i 1 1 AUTO PLAN ARE APPROXIMATE. w MW-7 CB MW i U COMMERCIAL- RESTAURANT B 7 M "8 -2 EAST SIDEWALL U AND RETAIL w a BASE EAST 0 - O 3CL 0 o w a p SW BASE(FOOT ) 2z O� 2Z w WEST BASE Q =U O U)i a BASE WEST QY ( ) 1 w N MW-1 GS-1 FOOT C-D c� MW NO.OF 1 ANKS TANK SIZE TANK CONSTRUCTION TANK CONTENTS INSTALLATION DATE REMOVAL DATE U MW GASOLINE N/A NOVEMBER 1982 SE BASE(FOOT B) m ® SW BAS 1 2,000 N/A GASOLINE N/A NOVEMBER 1982 L GAS CB FOOT C GAS GAS GAS 1 2,000 N/A DIESEL N/A NOVEMBER 1982 , — ' . 9 SE SIDEWALL Ss SE SIDEWALL 4 8,000 FIBERGLASS GASOLINE DECEMBER 1982 IN USE A—SS Ss : n ss (FOOT C) 2 12,000 2-WALL FIBERGLASS GASOLINE 9/24/2008 IN USE =3 —w w w . IN w: P WEST MAIN STREET (Route 28) 1 8,000 2-WALL FIBERGLASS GASOLINE 9/24/2008 IN USE NOTES:. co RICHARD GRIFFIN THIS INFORMATION WAS COMPILED BASED ON AVAILABLE HANDEX OF N.E INC.RECORDS AND s COUNTRY GORDEN NURSERY PARK PLACE CONDOS FISH AND LOBSTE LOCAL RECORDS,AND MASS DEP UST DATABASE Y 380 WEST MAIN STREET 398 WEST MAIN ST. OHN F.CARDARELLI TRUS N/A=INFORMATION WAS NOT AVAILABLE. 406 WEST MAIN STREET L FIGURE PROJECT NO. V0990 ° } 6� 3� O DRAWN: DEC 2011 SITE PLAN Z he m, Id 1,mdeded en this,Mt rt-1mfatlen hee Been k,.I,d rmm a d—,of 60 KLE/NFEL�ER DRAWN BY: ER/L.FERREIRA Id p w ,I 10 cnenge w�mom nonce Klelnlelder makes no i h""letkns o - Q warrentles.express or Implkd ee to eccumry rnmplatepess dmegness ar rights to ma use of w e ouch Informetlon.This document is nol Intended far—e1 a lend server pmduot—is 11 APPROXIMATE SCALE (feet) CHECKED BY: CUMBERLAND FARMS#V0990/#2142 G assigned or Intended es a co11—don design documerd.The use or misuse of Is Infmmenon - Bright People.R/ght Solutlons. W ponmmed on this grephk repmsemeWn is e1 me:ae dsk er me pert'uskg er misesmg me \\ FILE NAME: 395 WEST MAIN STREET = mmmedon. `� --kleinfelder.com HYANNIS,MASSACHUSETTS C¢J m V0990NOV14.dwg E _ o O!i o JAMES MORETTI LEGEND RESIDENTIAL 50 SUOMI RD. 110 \ 0 9O 3:1, U U) MW-10 MONITORING WELL CC M Q DESTROYED MONITORING WELL . E E DAVID SOMERO n RESIDENTIAL n 04 N 34 SUOMI RD. SOIL BORING LOCATION LU rQ o SHADY LANE ® CATCH BASIN J c� Qs SEWER MANHOLE OMANHOLE N ® MONITORING WELL 1 _ I D4 GAS VALVE E n wv — — — — WATER VALVE ASSESSORS MAP 269 O Lo ASSESSORS PAARRCCEL19196 I MM ELECTRIC METER J o MAP 269 eREN2 sTDRacE0 us-E9DETAL I PULL BOX rn CD > — — LIGHTPOST Li 1 — — W-9 0) U MISC.SIGN - U - 1 - .ASSESSORS 'i/i//� MW-11 MAP 269 / T 1 CON4ENIFNCE StORE EXISTING / -0- UTILITY POLE PARCEL 101 � UNDERGRWND CC USE-RESIDENTIAL . � rik Ie FUEL ` o EL TTANKS GUY WIRE Gs- SBa GS-3I GT-z /r its FENCE —OHW— OVERHEAD UTILITY LINE M 1 % MW U5 GT-3� ■°M. s E— ELECTRIC LINE u C9 i MW-8 —W— WATER LINE ASSESSORS MAP I T - w 269 f o SB-7 PARCEL 100 / I`M V7—'2 I - - N o - 1 AUSE-L 10 % — — — - _ GT-5 MASS U - I RESTAUUTY RANTON g % 1 U —D� �£_.. D - y PARSE CAR - I - e PROPOSED STORAGE cd p 1 j MW'6 — ELECTRIC LINE G GAS LINE c cU GS-1 SS-9 Mw—i S SEWER e_ �- MW 1 R I I WATER LINE , L ORPHAN UsTe r IDENTIFIED r E p DURING t .w s s s s s s s s CONSTRUCTION NI Vim.EL=2&6 . •� y - (W.F.) HEST MAIN STREET LLI - ed ff-naIC■fir nI J ■ w ■ w w w - N LL I M Q ASSESSORS .. ASSESSORS M U MAP 269 MAP 269 O - PARCEL 052 PARCEL 051 . O USE-AGRICULTURAL USE-OFFICES - • RETAIL - M rA N N E 17)w� 60 30 0 60 PROJECT NO. MA0990 SITE PLAN FIGURE <X< APPROXIMATE SCALE (feet) DRAWN: NOV 2016 I p p Z The information tnduaad on this graphic evresen atian has Been wmvita o-om a every of KLE/NF"lOCR DRAWN BY: ANG W LU O sources and is suoleot to charge wtllEoul notice.ieiemfamer makes no_rev esenratiens a CUMBERLAND FARMS#MA0990/#2142 2 2 H warrants.e,wroas or implied.as t aoouraor.cometa vimess.timeliness.or rights to ine use or CHECKED BY: such Informant-.This Element is not slontletl...I.o es a T. e or survey f the o nor is it �, BlightPeople./tight SO/UtlO/li - QQ W tlBS�e�e°a°o�mis 9rep0ic represenraGon is et the solenflsk of tna parrysusingfornmisualrEg the SOURCE: COASTAL ENGINEERING COMPANY SITE PLAN CFG7.0 \�`■_�� FILE NAME: 1 395 WEST STREET www.kleinfelder.com HYANNIS,MASSACHUSETTS Q ^'°^^ati"k V0990DEC16NS.dwg W LEGEND: t — — — Approximate Property Line 17: sM Storm Sewer Line t� r Water Line Q I —Ws-ms- Natural Gas Line ® Catchbosin James Moretti 82.00 Utility Pole Residential ® Soil Boring B-1 advanced on 10/31/00 by ECS. , Monitoring Well with 50 Suomi Rd. VW-10 Groundwater Table elevation as W-10 (81,95) measured on June 21, 2005. • Soil Borings BMW-4 and BMW-7 D advanced on 04/18/02. David Somero General Notes: Residential Site plan prepared from o Town of Hyannis 34 Suomi Rd. S it Assessors Map, Site Plan by ECS, IlA D Y L A N E and Site Reconnassaince by ENSR. All locations, dimensions, and property lines depicted on this plan are approximate. This plan should not be used for construction or David somero land conveyance 82.50WOyne Zercis nce Y° purposes. Vacant Horizontal, and vertical locations of wells, and 30 Suomi Rd. Residential selected site features determined through 67 Shady Lane measurements made by representatives of ENSR. Carl E. Mueler Wayne Zercis Residential Vacant CLIENT 65 Shady Lane 22 Suomi Rd. C amber• d Parma RESIDENCE RESIDENCE yW_g 777 Dsdlsn S)<oet Caft Ifltb Thoedore Hyora YW-11 Residential CUMBERLAND VACANT VACANT I PROJECTFARMS TITLE 18-20 Suomi Rd. REGIONAL WLSI MAIN I OFFICE I AUTO CFI # 2142 A d I I 395 West Main Street o Hyarrtli% Massachusetts I o I Cornelius Hickey -�I CB U5T5 I FIGURE TITLE Commercial Site Plan►dr ANOPY i 379 W. Main St. 11W-B ,p -71 Alfred and Leah Zercis r " PUMP ' PUMP I APPROVED BY REVIEWED BY 6 I I SFOOD ORE I I 405 WEST MAIN D.ESPY D.MARGARIT AUTO A_tl ISLANDS ISLANDS I I IMtTyQ�� DRAWN S&M L.FERREIRA 1"=60' 4 � : I 8YW- ` — �1'_1 I JOB NUMBER Jig 0 3o as so C R _ 2140-251 7 27 05 Scale in Feet 1 _ / / -GAS- -Ws-Ws-GAS- S-Ws-Ws-WS-Ws—GAS-WS- ss ss ss a ss iM C� aWatbn r WEST MAIN Route 28 rSTREET 95 state street Na. of Tanks Tank Size Tank Construction Tank Contents Installation Date Removal Date %manacknetts 1 8,000 Fiberglass Gasoline December 1982 In Use (M)M-39W 2 8,000 Fiberglass Gasoline December 1982 In Use 3 8,000 Fiberglass Gasoline December 1982 In Use Richard Griffin 4 8,000 Fiberglass Gasoline December 1982 In Use COUNTRY Park Place Fish and Lobster FIGURE2 Condos John F. Cardarelli Trust Notes: GORDEN NURSERY 398 West Main Street 406 West Main Street � ENSR AECOM o This information was compiled based on available Handex of N.E Inc. records and local records N/A = Information was not available. Sao west Main Street SHEETI o< 1 w LEGEND: Z w J Approximate Property Line sw Storm Sewer Line t� w Water Line -GAS—GAS— Natural Gas Line ell ® Catchbasin James Moretti aC- Utility Pole 82.00 ® Soil Boring B-1 advanced Residential f on 10/31700 by ECS. Monitoring Well with 50 Suomi Rd. ww-lu (MW-10 Groundwater Table elevation as 81,95) measured on June 21, 2005. • Soil Borings BMW-4 and BMW-7 advanced on 04/18/02. David Somero v General Notes: Residential Site plan prepared from a Town of Hyannis 34 Suomi Rd. s i7 Assessors Map, Site Plan by ECS, it A D Y r A �r E and Site Reconnassaince by ENSR. L ti 1� All locations, dimensions, and property lines depicted on this plan are approximate. This David Somero plan should not be used for construction or 82.50Wame Zerris land conveyance purposes. Vacant Horizontal, and vertical locations of wells, and 30 Suomi Rd. Residential selected site features determined through 67 shady Lane measurements made by representatives of ENSR. Carl E. Mueler Wayne Zerris Residential Vacant GLIENT _ 65 Shady Lane 0. Cumber add Farms 22 Suomi Rd. RESIDENCE RESIDENCE �,_y 77/Dedlan Street Q Ceti Ma?tseadueelte Thoedore Hyora CUMBERLAND I PROJECT TITLE _11 Residential FARMS VACANT VACANT 9 18-20 Suomi Rd. I REGIONAL WEST MAIN OFFICE I AUTO CFI # 2142 Q I I 395 West Main Street o I Hyannis, Massachusetts Cornelius Hickey -3 CB UO I FIGURE TITLE a MW_3 Commercial � o k Site Plan Ir MW-7 N ANOPY 379 W. Main St. , MW-B Alfred and Leah Zerris r ■ w-+ PUMP PUMP APPROVED BY REVIEWED BY 6 I I FOOD ( 405 WEST MAIN �. D.ESPY D.MARGARIT Q STORE I AUTO DRAWN BI1p'^' lI ISLANDS ISLANDS I I Y SCALE L.FERREIRA 1"=60' E 4 0 30 45 60 BMW- � MW-lI JOB NUMBER DATE\ Scale in Feet — — 2140-251 7/27/05 -GAS- GAS GAS AS-GAS-GAS-GAS-GAS-GAS-GAS- SS SS-SS-SS-SS a ENSR Corporation w WEST MAIN Route 28 STREET w 95 State Street No. of Tanks Tank Size Tank Construction Tank Contents Installation Dote Removal Date Saga(nore,Massachusetts 1 8,000 Fiberglass Gasoline December 1982 In Use (508)888-3900 2 8,000 Fiberglass Gasoline December 1982 In Use 3 8,000 Fiberglass Gasoline December 1982 In Use Richard Griffin 4 8,000 Fiberglass Gasoline December 1982 In Use COUNTRY Park Place Fish and Lobster FIGURE2 Condos John F. Cordarelli Trust ENSR AECOM Notes: GORDEN NURSERY SHEET I o This information was compiled based on available Handex of N.E Inc. records and local records 396 west Main Street 406 West Main Street 380 west Main Street SHEETI N/A = Information was not available. . - _ ... _: :,,.. ,a."., ......., ._ �. .;. m ....., ... s. s. _ n .. .:. a ...'v!...«- 9F:'i^�. s ..7 ... «........ 't 5•-^§' tv.. .sC... .. <....+�'.e&` v'.fi. 'i .. __. _•.... ,... ... 7. .... ,. ir_ e. .. .Yf.. -. .,. - - a ..-+at r.-'�'-'i'3F.mv.-. ..-.... .3'_a:wc r. .t` _._ r*" .s..rM' ._. ., `k.-V'^'fi'. "v.i."e33+hYt �: 'u9CA1^.e- '�f'F.'Yixi':k'. k«..&._;�5a,. ....,.... _ -.. .,...... - __. .. ._.. , --, . . ,. r >.. ... V+._.:.::. P�! .A ..trw.._. S.. T"Mxaf•:,.. _.. -^1.�........:.... ..'tL<..'..t..t ..M f -xx _ �`..�':':5a.. .r .. S +A- , ..-313G!�..=YcS�fi�! ..' .:.. � �'.. s.. ',. -. ... .. . v..._. .. _:g.� <..,;.y. ..r,,... ...,._,'sH7v^k:�•4'rv..!RC:...R.lY�.0.:.§2L'h,..ta.;m�..;�,7!':M4�a.rL.r�.�'^.�:t4 f6."R,5'1?.?-a,.-.'D.,, .. _ - ..,.. .. ..5.._.. � 8#.>.:: .aT;z ....':.(^:'Gd`+k»_a_k"Att"L24 Y.•^��.,:*:.TP t,..w�". +t.V.F'�:yC:�U ....c..'t?Y"yY ,...,.1. ,..i.. .k.R .r,XF-;,.e.... ,.v..r.r .r,.:_..e T'.. .v-....sk v:�-k-,.. ��"'Ek k,,.'ay.,,2t '�,.. '8:. 3. .. _.V 45 -i _ { ZS 1 6 i{ `6LbCK OP'1 MG) M. G) I x . : ...I 4 x4 /4 STL.COL.� O a _ tl /4 x8 CAPS Bt�SE 8 IB 5P IT L t2 PLATES CONC.BLOCK YYY. 6 Z } IN 1L - 5 IV swr=LvlWC7 DISPLAY N. _N SAFE 8 O ` D 2AV O 3 z o _ , 4 u UT _m O K r U �iNELv(wG I „ ' 2 �o I W of I STANDP PE 12 r 1 --, ;115 V.2UA:CLCTS ; u 0 5"F- V I1.1G W 2 L � L_ _ 3 O _ ,-r 0 pI u G E 6 U _ 1 '00c0 C� o _ ao DI 5. La ING i I `z0 S ELY r p� 4`. a .. C 1 I > . J _ • tV 11 r .C.CA L _. ,4 I.C. CAB. WIWy� l.C. CAB. PEGBQOJZD B�tDW WS 2 12 PE w WilD T to — — f t M.G. ZQ_ _ N ,.. _ BLfJCIL NG} 5- 4 .. CS S S G _ DCK�Q SG�Ef�I.,ILE : I\J_UTES 1NTEIZC ll�! l.� PE . � . o C G o >✓LUOt2 - WALLS _ EILIN � � 1 NT fOR St1RFACES 01= BLOUC'WALLS W� 2UOt�l 1 3 X 7 ;.ALUM , GLASS F Nt51-i t ER .. � � '- 0 ROPOAM INSULATION -OETWEEN 2 Y3 � ,, �°- 1/2.tom) STY -�-�`° gyp. 6 o w CAOLEQ : 'ED G _ :IL IL plc. 2 3 .v7 kIOLLOW METAL 57UD5 5 ,4GED 0 Z-0 OvS2 POLYETP"?L F-FILM. f 0 O U DEQSIDE OP METAL DEC'4C. EXT�Np INSUL:TO N v � a E SALES AV-EA VT P 3 2_ X6 11JSU1.ATED `` c�ovER vy/ct4ss c wooD t It rNo w/Ft.AM W FST -M.&IN 5T2GET 49 SUOM i I2�iL� 517f2l=AD OF:200 O L2 LE5S• EXCWDS 5UQPACE --- _ . C40 WALL ABUTS BtOcv- WALL. SEE iNT2TC3t2 > ItS1-t SPECg. _ f-i NN I S MA. « r <M 1=P C EoXY P NT OVER; C.Oi`lC _ �ovED e AJ .. 1 _ - FLOOt2 TG 13E 4 C04.1C. SLAB (yJEtZ 6MIL. GCiLYFILM scwE. �4 'I C) on�wN eT F. S. `_. .. SULATION. - 6 PACT:'FILL W 1 PE1ZiM1=CER 11J : _ - `; lC ILENtPLY �I22L X. J_ V.A.Tt�.E. DATE: ! V� .. REVISED �GK�T TR SB ST STILE VT VINYL A E C7 S - p ` lt�1G 5 G < . CA1�S 1�1 SS• " .. P WOOD _ ANEL U.A ;_. __ r 77.7..f�CDI-lAiVi :� D NG NUMBER ST( C ss A , 1S►CAU C TILE . LA , 1-II OU �P IIIIIm _NfT YF)00 op-00 lo 2 i6 7 Tk,'t OF,-M;K., fNStJI.A-rTOM ULL T4k, IPOL�Y' L oo 0 .7�_oo oo oo oo JE e�,Pot:�:<C-r., I -4 4 4 4o 4 Z:\V/VAL.1-T I r-59 S a'-0 0,C': r_Y Fl 3a P.�s IM.C. I7 MA t:�r(AR-b APPROVED qv.. 4 I -A,7 ItN (!;6­7 I NOrE : -ILITY LOCAT'IONS ARE APPROXIMArE ONL Y UNDERGROUND U T -ACT ALL U TIL I TY COMPANIES- PRIOR TO CONSTRUCTION, J CON7 Route 28 -W E S 7" MA IN S rREEr ALL EXISTING BUILDINGS , ARE 7'0 BE RA ZED. ALL DRAINAGE RUNOFF SHALL BE RETAINED BY MEANS OF 38 LEACHING CA rCH BASINS . 8 " WG16r Rim��36.35 t 14 Sewer S.M.H -=—-------------- 4" Gas PRECAST LEACHING CAMHBASIN 4 0— wq. UP H-20 --L---OADING 95.40 51go BENCH MARK NO C.B. Existing Building Rim x 36.33 Inv. 33.6 Standard US.C. G. S. --j M28 OK Elevation 40.96 C) 9= C3 C3 C3 4 O-� M C3 0 C T F F Gas Island M M co Im ED ED C 4/.00 Existing I WASHED WASHED Go s ED 0 0 C7 SrONE Concrefe Pod with U.P Vo rie ty Store STONE DO 0 M M Canopy Hyannis; S to tion 1:3 OC 39 KGWGsok * C3 E= Wk Z 65 ' lb'�Of �A5 � 31 NORTHEAST EOUITIES 3 6'- 0 con WG1* CORP. -4 Vl�� 12 0 �op-C.B. A% P R`OPOSED 8/0 S. F Ri 18.25 FOOD STORE ------- 0 -ILL Concrete 0 -CAT -15A -5=,I0 10 Block 4 -8000 gallon gas storcg e tanks 38 pra�. C.B. o Ex�07 Me tol Existing L ibEIS,1? 0 Gor0ye LOCIS Building A suo RD. AWIM� V 46'01A 4-0 38 V BEACH C 'RA16VILLE eoncrefe WdIA .......... WOWOuTtAtC MAt4PCLE ..SAGE� RD. 3,5 , 36 35 2000, 37 5 PROPOSED BUI LDING (b I It REN 77AL RENrA L RENrAL 1440 SF. 1400 S.F 1400 S.F 36, IVIF FF 40.00 WILLIAM A. ROSENGREN U.P 1 .3 5. 40 JI ................I 36, NIF W1 L LIA M A ROSENGREN S1 rE PL A N OF LAND IN H , YA IVIV 3 M� ASS DRAWN FOR VS.H. REALTY INC. . SCALE-- I = 20 JUNE 14 , 1982 LEGEND Revised: September 27, 1982 - PROPOSED ELEVATION Voutri�)Ot a W/ e b by Co. ENGINEERS a LAND SURVEYORS Health Dept Town of Bamstable 0 COUNTY RD. PLYMPTON, MASS. [BOW MAR 0 J—, 4 ExIs ting I 7 J conc. ILREON 14 �A, 'g, EQUIPM34T SCHEDULE O 1 FROZEN CARBONATED TAYLOR COMPANY - 4 FLAVOR BEVERAGE) FCB FREEZER 2 1 ICE/BEVERAGE DISPENSER SERVEND -8 FLAVOR W/ MANITOWOC OUIET CUBE SERIES 450 REMOTE ICE CUBE MACHINE O3 3 BEVERAGE UNIT (W1 CTUPP. LLC L ID & STRAW DISPENSERS) 4� 1 BAG-IN-BOX RACK SYSTEM 5O 1 SANDWICH COOLER 4FT. INLINE SANDWICH CASE STORE FIXTURES, INC. © 1 MILK & CREAM DISPENSER COLDSTAR INC. *CS2R O 1 CONDIMENT RACK CUSTOM DESIGN INC. 80 1 LID RACK CUSTOM DESIGN INC. - VERT. 3 LIDS i 9 2 TRASH RECEPTICLE . , � WALK -IN COOLER " ° 10 1 COMMERCIAL MICROWAVE PANASONIC *NE 1056 - (1000 - WATT COMMERCIAL) 6 DOOR IARDCO 26' 'I O 1 MICROWAVE CONDIMENT RACK CUSTOM DESIGN h 12 __ _. -_._-_ __.--_-_--_. 1 6 FLAVOR CAPeUCCINO MACHINE CECILWARE *GB6M-10-LD - I .. RTORRD S.S. 4O 13 0 "EXOTIC CHOICES" DISPENSER CECILWARE *GB3-LD L" WRYER TEA JUICE DAIRY MILK MILK 4- EW AG 14 0 TEA RACK & RISER LIPTON 15 1 QUANTITY BEVERAGE DISPENSER FETCO - LUXUS *LD15 - 1.5 GAL. \ , \ Y~I O 1 UNDER COUNTER CUP DISPENSER (5 CUPS) PANELS ELECTRIC M m w 5 "' 17 1 AIRPO-I MERCHANDISING RACK CURT IS 6 AIRPOTS °- 2'-6" SNACKS i 18 1 DUAL AIRPOT 'COFFEE BREWER BUNN, INC. *CWTF TWIN APS on Q - _ _- --- n a 1 COFFEE GRINDER GRINDMASTER *19055 —� cc cc —N 20 1 QUANi ITY COFFEE BREWER FETCO CORP. *CBS-511­115 '1 DR. C E irm 21 0 TRAVEL MUG RACK (COFFEE) 9O 10 0���,, DEEP BASIN STAINLESS STEEL HAND SINK 8 1 HAND SINK (LACROSSE *0116CD W/ GOOSENECK FAUCET ASSEMBLY) 1 DR. ink �"'� 6 _ _ -- CJ 0 SHELF BAKERY CENTER CUSTOM DESIGN INC. (SHELF - MOUNTED WOOD 7 24 0 SHOCK COFFE RACK/AIRPOT/CCFFEE/CUPS - PRICE MASTER CORP � _jH 15 )) 25 0 GLASS DISPLAY DOOR SIZE/STYLE 1 2 O 3 en my CZ1.1 CZ1.1 - -- 26 0 GLASS DISPLAY DOORS SIZE/STYLE li ui(k w �'¢ 12 27 ISLAND CANOPY D COOLER STORAGE SHELVING MICRO WIRE PRODUCTS INC. - 40 X 15 BACK UNITS ;,, m 3 8 ISLAND CANOPY � 18 (8 0 COOLER STORAGE SHELVING MICRO WIRE PRODUCTS INC. - 41 x 21 FRONT UNITS EL. = 14'-9" A.F . Q EL. = 14'-9" A.F . 4 CHIP5 ( 14y 1 2 BAY SINK 24"X36" WITH DRAIN 12" DRAIN BOARD ��(j(` - 19 rn 3 IA ' enRITO Fag rc;/�� RETAIL SALES AREA N CEILING EL. = 8'-0" A.F. KNEE WALL KNEE WALL VCT FLOOR � i . 3 GUM/MINTS 2' SAFE GUM/MINTS r u 5' CHECKOUT SECTION cn W/3 RS 6' CI ECK TD g OFFICE4' Ub 29 s CIGARETTES Pf EQUIPMENT PLAN ` � s a4cztof b SCALE: 114 = 1 -0 C Cam'" L c,, 6:j .�. L0 w 6; C_� L� L))I _ OCT 2 0 2006 REVISIONS STORE 2326 DATF REV. BY. DESCRIPTION HYANN IS MA. 09/27/06 CMP REMOVE-- ALL OF EXISTING CHECKOUT AREA �' 0990 SCALE: 1/4" = T-O" INCLUNNG SAFE AND SINK AREA, INSTALL !� NEW 133FT CHECKOUT W/ 2FT SAS AND - 490 � DATE 07/24/06 3FT MANAGER OFFICE, INSTALL MOP SINK `'�n1� � � � �Or FILE.- DRAWN BY: CMP 10/19/06 CMP INSTALL 2 BAY SINK BEHIND 777 Dedham Street Canton. Massachusetts 02021 CHECKED BY: cHECKoIUT AREA EQUIPMENT PLAN CZ1.2